[Imported] Client Questionnaire
Name:
*
Date of Birth:
*
-
Month
-
Day
Year
Date
Height/Weight:
*
Address:
*
Emergency Contact:
*
On a scale of 1-10, how healthy do you consider your diet to be? (1 being the least, 10 being the most)
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Worst
1
2
3
4
5
6
7
8
9
Best
10
1 is Worst, 10 is Best
Do you consume any alcohol? If so, how many times a week?
*
Do you consume tobacco? If so, how many times a week?
*
Do you consume caffeinated drinks? If so, how many times a week/daily?
*
On a scale of 1-10, how would you rate your level of stress, if you are experiencing any?
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Worst
1
2
3
4
5
6
7
8
9
Best
10
1 is Worst, 10 is Best
How do you manage your stress?
*
How many hours of sleep do you get? Do you feel well rested?
*
What is your occupation? Does it require extended periods of sitting?
*
What is your work schedule? (hours worked, and days off)
*
Hobbies:
*
What specific goals are you hoping to achieve by working with a personal trainer?
*
Fitness & health goals?
*
What gym(s) do you currently go to?
Preferred time/days in the gym:
*
Injury history if any?
*
Surgery history if any?
*
Have you done any rehabilitation for any injuries or surgeries?
*
Heath conditions?
*
Are you cleared medically for physical activity?
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Physician Information:
Submit
Should be Empty: