Health History Questionnaire
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
What is your age?
Years
What goals do you hope to accomplish by working with me?
What type of training are you interested in?
Powerlifting
Weight loss
Muscle gain
Group training
Other
Fitness expertise
Beginner
Intermediate
Advanced
How motivated are you to reach your goals?
Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
Please rate your current nutrition/ eating habits:
Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
What goals do you hope to accomplish by working with me?
What is your occupation? Is your career or home life physically demanding? If so, please give examples. (E.g. standing for long periods of time, lifting or moving 50-100 pounds on a regular basis)
Do you have any known health conditions or restrictions?
Have you worked with a trainer in the past? What did you like about them? What didn't you like?
Do you have a gym membership/ access to gym equipment? If so, please specify where/ what equipment is available.
What is your approximate monthly budget for coaching/ training?
Preferred coaching style
Online
In person
Hybrid (combination of online and in person)
Unsure
Emergency Contact Name
Emergency Contact Phone Number
How did you hear about us?
Submit
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