Personal Training Form
Name
First Name
Last Name
Email Address
example@example.com
Phone Number
-
Area Code
Phone Number
Date of Birth
-
Month
-
Day
Year
Date
Occuption
Health & Medical History (PAR-Q)
Do you have any existing medical conditions or have you had any major surgeries? (e.g., heart disease, diabetes, asthma, joint replacement) If yes, please explain.
Are you currently taking any prescription medications? If yes, please list them and their purpose
Have you experienced any chest pain or discomfort at rest or during physical activity in the last month?
Yes
No
Do you lose your balance due to dizziness or have you ever lost consciousness?
Yes
No
Do you have any bone or joint problems that could be aggravated by exercise? If yes, please explain.
Is there any other reason you should not participate in physical activity?
Have you been medically cleared to participate in a physical activity program?
Fitness Goals
What are your top 3 fitness goals? (e.g., lose weight, build muscle, improve endurance, increase flexibility, train for an event)
What is your desired timeframe to achieve these goals?
3 Months
6 Months
9 Months
1 Year
What motivates you to work towards these goals?
What does success look like to you? (e.g., fitting into a certain size, lifting a specific weight, running a 5k)
Fitness & Exercise History
On a scale of 1-5 (1 being sedentary, 5 being a competitive athlete), how would you rate your current fitness level?
Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
How many days per week do you currently exercise?
What types of exercise do you enjoy most?
What equipment do you have access to? (e.g., full gym, dumbbells, resistance bands, no equipment)
Lifestyle & Habits
How many hours of sleep do you get per night, on average?
On a scale of 1-5 ( 5 being highly stressed), how would you rate your typical stress level?
Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
Do you have any dietary restrictions, food allergies, or preferences?
How often do you eat out or order takeout per week?
What are the biggest challenges that might prevent you from sticking to a workout plan?
Waiver and Acknowledgment
By signing below, you acknowledge that you are voluntarily participating in a physical exercise program. You understand and agree that you are solely responsible for any risks and injuries that may occur as a result of your participation.
Signature
*
Date of Signature
-
Month
-
Day
Year
Date
Continue
Continue
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