Personal Training Client Intake Form

Personal Training Questionnaire
Part 1. Basic Information
Full Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Date of Birth

DayMonthYear
Age
years
Height
cm
Weight
KG
Emergency Contact

NamePhone number
Are you interested in in-person training or virtual training?
Part 2. Lifestyle Information
What do you do for a living?
What is the activity level at your job?
Do you follow a regular working schedule? Do you work days, afternoon or nights?
Please list any physical activities or hobbies that you participate in outside of work and scheduled exercise, if any
Part 3. Exercise History
What exercise activities, if any, do you currently take part in? (e.g. running, weightlifting, group exercise etc.)?
How many days a week do you get at least 60 minutes of moderate-intensity exercise?
Please tell me about your past experience with resistance training (i.e. lifting weights)
How long have you been practicing resistance training?
Part 4. Medical and Health Information
Has your doctor ever said you have a heart condition or high blood pressure?
Do you ever feel pain in your chest at rest, during activities of daily living, or when you do physical activity?
Have you ever been diagnosed with any chronic medical condition? Please list condition(s) here.
Are you currently taking any prescribed medications? Please list medication(s) here.
Do you currently have (or have had within the past 12 months) a bone, joint, or soft tissue injury? Please briefly explain.
Has your doctor ever said you should only do medically supervised physical activity?
Part 5. Diet and Nutrition
On a scale of 0 to 10, how healthy would you consider your current diet? (0 being very unhealthy, 10 being very healthy)
Your current diet could be best characterized as:
Part 6. Your Fitness Goals
What is your primary fitness goal? (select all that apply)
Please briefly describe your fitness goal(s). What motivates you to achieve these goals?

Timeline for achieving your goal(s).

Rows	8 WKS	16 WKS	24 WKS	32 WKS	40 WKS	1 YEAR
NOW

How often are you able to train a week to reach your goal(s)?
Please rate your motivational level to reach your goal(s)
Are you currently exercising regularly (at least 3x per week)?
Have you trained with a personal trainer before?
What kind of training did you do?
At what times during the day would you prefer to train?

Other
How often do you want to do Personal Training a week?
Please Choose
What are your expectations of me as your Personal Trainer?
How did you hear about Garage Fit Studio?
Please Read The Following Terms and Conditions
1.) CANCELLATIONS

Cancellations should be made at least 24 hours in advance of a scheduled session. Sessions cancelled less than 24 hours in advance will be charged in full to the client.

2.) LATE ARRIVALS

Each session shall be 1 hour in length. Sessions will not be extended (unless time is available) due to the lateness of the client or due to interruptions caused by the client.

3.) ALL THE INFORMATION I HAVE GIVEN IS CORRECT

All the information on this form is correct and to the best of my knowledge. I have sought and followed any necessary medical advice. I understand that all the information given will be kept confidential.
I AGREE TO THE ABOVE TERMS & CONDITIONS!
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Personal Training Questionnaire

Part 1. Basic Information

Part 2. Lifestyle Information

Part 3. Exercise History

Part 4. Medical and Health Information

Part 5. Diet and Nutrition

Part 6. Your Fitness Goals

Please Read The Following Terms and Conditions