Personal Training Consultation Form

Personal Training / Online Coaching Enquiry Form

Please fill in all boxes
Full Name

First NameLast Name
Gender
Date of Birth

MonthDayYear
Age
years
Height
ft
Weight
If unknown that's okay
Phone Number
Format: (000) 000-0000.
Email
example@example.com
How do you prefer to be contacted?
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:
Are you a current cigarette smoker?
Please rate your readiness for change.
What following goals does best fit in with your goals?
Do you have any dietary restrictions?
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
NOW

Are you currently excersising?
Is it okay to post photos and videos to social media of training and/or progress photos?
Are you okay with Progress Photos (taken personally)?
What are your expectations on me as your Personal Trainer?
Do you have any dietary restrictions?
Should be Empty:

Personal Training / Online Coaching Enquiry Form