She Shred Fitness Questionnaire

Personal training Your starting point.

Fitness Consultation Questionnaire
Please be as accurate as possible - Brie’Jea
01
Get to know you
Consultation
Email
example@example.com
Full Name

First NameLast Name
Contact Information

Phone NumberEmail Address
Gender
Date of Birth

MonthDayYear
Age
years
Height
FT
Weight
LBS
02
Your everyday rhythm
What do you do for a living?
Whats the activity level at your job?
Do you follow a regular working schedule, do you work days, afternoon or nights?
How often do you travel?
Please list the physical activities that you participate in outside of the gym and outside of work:
03
Health & wellbeing
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?
Has anyone of your immediate family developed heart disease before the age of 60?
Do any diseases run in your family?
Do you suffer from diabetes, asthma, high or low blood pressure?
Please list:
Are you a current cigarette smoker?
Your current diet could be best characterized as:
04
Goals & motivation
Please rate your readiness for change.
What following goals best fit in with your goals?
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.
05
Your training plan
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?
What are your expectations of me as your Personal Trainer?
# of Weekly 1:1 Online Training Session, NO Nutrition Coaching
# of Weekly 1:1 Online Training Sessions and Nutrition Coaching
06
Before we begin
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!
Should be Empty:

Fitness Consultation Questionnaire

Get to know you

Your everyday rhythm

Health & wellbeing

Goals & motivation

Your training plan

Before we begin