Wellness Coaching Questionnaire

Personal Training Questionnaire

(please complete in full)
Full Name*

First NameLast Name
Gender

MaleFemale
Email*
example@example.com
Phone Number
Age
years
Height
cm
Weight
KG
What do you do for a living?
Whats the activity level at your job?

None (seated all day)Moderate (light activity such as walking)High (heavy labor, very active)
What is your reason for training?

Lose weightImprove fitnessBetter healthBuild confidenceTone up/build muscleOther
How many pounds would you like to lose/gain, or what is your health goal?
Do you eat 3 meals a day?

YesNo
If not, which meals do you skip?

BreakfastLunchDinner
Do you generally snack?

YesNo
How much water do you drink daily?

1 glass2-3 glassesfull gallon always
What else do you currently drink?

TeaJuiceSodaCoffee/Energy Drinks
When are you the most tired?

Right when I wake upMid-dayAfter workOther
Please rate your readiness for change.

12345678910
Do you have any health conditions? Please list below
What do you need the most help with?

AccountabilityJust starting!I've hit a plateau & I need to change thatOther
Are you willing to financially commit to changing your life?*

YesNo
How do you prefer to be contacted?

CallTextEmailOther
Thank you for your interest in personal training and online coaching! I can't wait to get you started helping to achieve your goals. I will aim to get back to you within 24 hours!
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Personal Training Questionnaire