Personal Training Consultation Form

sculPTwithamy PT Consultation Form

Please fill in all of the questions below before submitting your form.
Personal information
Full Name

First NameLast Name
Email
example@example.com
Gender
Date of Birth

MonthDayYear
Age
years
Height
cm
Weight
KG
Lifestyle Information
What is your occupation?
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. For example, running, horse riding etc.
Medical and Health Information
Do you have any health conditions? If so, please explain in detail below.
Do you currently have any injuries or any reoccurring injuries? If so, please explain in detail below.
Do you smoke?
Are you experiencing any stresses or motivational problems?
If yes, please explain why.
Do you suffer from diabetes, asthma, high or low blood pressure?
If yes, please explain below.
Your current diet could be best characterised as:
Your Goals
Which of the following is the best fit for 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	No timeline
NOW

How often are you willing to train a week to reach your goal?
Are you currently excersising regulary (at least 3x per week)?
Have you trained with a personal trainer before?
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 on me as your Personal Trainer?
Please Read The Following Terms and Conditions
By submitting this form, you agree to the following:
- Accuracy of Information – You confirm that the information provided is accurate and complete to the best of your knowledge.
- Health & Safety – You acknowledge that it is your responsibility to consult with a healthcare professional before beginning any exercise program.
- Data Privacy – Your personal information will be used solely for consultation and communication purposes. It will not be shared with third parties without your consent, except where required by law.
By submitting this form, you confirm that you have read, understood, and agreed to these terms.
I AGREE TO THE ABOVE TERMS & CONDITIONS
Signature
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sculPTwithamy PT Consultation Form