Personal Training Consultation Questionnaire

Full Name*

First NameLast Name
Contact Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Gender

MaleFemalePrefer not to sayNon Binary
Date of Birth

DayMonthYear
Age
years
Height
cm
Weight
KG
What do you do for a living?
Whats the activity level at your job?

None(seated only)Moderate (light activity such as walking)High (heavy labour, very active)
Do you follow a regular working schedule, do you work days, afternoon or nights?
How often do you travel?

RarelyA few times a yearA few times a monthWeekly
Please list the physical activities that you participate in outside of the gym and outside of work:
If you have any diagnosed health problems list the condition(s).
If you are on any medications, please list them.
What additional therapies are being undertaken for the given health problem(s)?
If you have any injuries, please list them.
What additional therapies are being undertaken for the given injury?
Are you experiencing any stresses or motivational problems?

YesNo
Has anyone of your immediate family developed heart disease before the age of 60?

YesNo
Do any diseases run in your family?

YesNo
Do you suffer from diabetes, asthma, high or low blood pressure?

YesNo
Please list:
Do you currently smoke/vape?

YesNo
Your current diet could be best characterised as:

Low-fatLow-carbHigh-proteinVegetarian/VeganNo special diet
Please rate your readiness for change.

12345678910
What following goals does best fit in with your goals?

Improved healthImproved enduranceIncreased strengthIncreased muscle massFat lossRace (5k,10k,half marathon,hyrox etc)
What is your goal with your training?
Why?

TImeline for achieving your goal.

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

How often are you willing to train a week to reach your goal?
Please rate your motivational level to do what it takes for reach your goal.

12345678910
Are you currently exercising regularly (at least 3x per week)?

YesNo
Have you trained with a personal trainer before?

YesNo
What kind of training did you do?
At what times during the day would you prefer to train?

MorningMid-DayAfternoonEvening
What are your expectations on me as your Online Coach?
Do you have access to a gym? If so, please state below
Here are the packages we offer:

Macro Only - this will give you your macronutrient target (protein, carbohydrates and fats) to keep you on track to acheive your goals.

One Off Plan - this is a training plan for you to follow on your own without any feedback or check-ins.

Ongoing Nutrition Plan - this is a full meal plan completely bespoke to you with weekly check-ins which will be tweaked as and when needed.

Ongoing Training Plan - this is a full training plan designed around your lifestyle and your goals. Whether that is to build muscle, lose body fat, increase strength, general fitness or if you're training for a race - we've got you covered.

Full Nutrition and Training plan - the full nutrition and training plan is designed to optimise health, performance and sustainability. It combines structured workouts with a balanced diet to support both energy needs and recovery.

Every plan we offer will be completely designed to you. We don't do generic plans at CB Fitness.
Which package are you interested in?

Macro onlyOne Off PlanOn going Nutrition OnlyOn going Training PlanFull Nutrition and Training Plan
1.) LATE PAYMENT

Late payment will result in your account being suspended until payment has been recieved. Your check in will not be done until the following week.

2.) COPYRIGHT

All information and gudiance supplied by CB Fitness should not be given to a third party without prior consent given from CB Fitness.

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!

YesNo
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