Personal Training Consultation

Full Name

First NameLast Name

Gender

Date of Birth

MonthDayYear

Age

years

Height

FT.IN

Weight

LB

Email

LB

Phone #

LB

Instagram

LB

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?

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.

If you have any injuries, please list them.

Are you experiencing any stresses or motivational problems?

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

if yes please list:

Your current diet could best be characterized as:

Please rate your readiness for change.

What are your fitness goals?

TImeline for achieving your goal.

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

What are your expectations on me as your Personal Trainer?

If I gave you a plan to follow would you be able to spend 3 hours per week working on it to achieve the results you want

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?

I AGREE TO THE ABOVE TERMS & CONDITIONS!

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