Online Personal Training Consultation Questionnaire

Online Personal Training Consultation Questionnaire

Please fill out form below, and I will be in contact within 24 hours.
Full Name*

First NameLast Name
Email*
Phone Number*
Gender*

MaleFemale
Date of Birth*

MonthDayYear
Address*

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Age*
years
Height*
cm
Weight*
KG
What do you do for a living?*
Whats the activity level at your job?*

None(seated only)Moderate (light activity such as walking)High (heavy labor, very active)
Do you follow a regular working schedule, do you work days, afternoon or nights?*
How often do you travel?*

RarelyA few times a yearA few times a monthWeeklyVaries, but can let personal trainer know for workout adjustments
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.
What additional therapies are being undertaken for the given health problem(s)?*
If you have any injuries, please list them.*
What additional therapies are being undertaken for the given injury?
Are you experiencing any stresses or motivational problems?*

YesNo
Has anyone of your immediate family developed heart disease before the age of 60?*

YesNo
Do any diseases run in your family?*

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

YesNo
Please list:
Are you a current cigarette/vape smoker?*

YesNo
Your current diet could be best characterized as:*

Low-fatLow-carbHigh-proteinVegetarian/VeganNo special diet
Please rate your readiness for change.*

12345678910
What following goals does best fit in with your goals?*

Improved healthImproved enduranceIncreased strengthIncreased muscle massFat loss
What is your goal with your training?*
Why?*

TImeline for achieving your goal.*

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

How often are you willing to COMMIT to train a week to reach your goal?
Please rate your motivational level to do what it takes for reach your goal.*

12345678910
Are you currently excersising regulary (at least 3x per week)?*

YesNo
Have you trained with a personal trainer before?*

YesNo
What kind of training did you do?
How often do you want to do Personal Training a week?*
Please Choose
What are your expectations on me as your Personal Trainer?*
I will be in contact to collect payment via a invoice from Stripe Express, and then provide accounts/services with login credentials for everything included in program. If a coupon code was used it will be reflected on invoice sent!

50% discount is provided to First Responders/Military. Please email huntergibsontraining@gmail.com for coupon code, with proof of service. (Government ID, Military ID). Once received, 50% discount will be added to all monthly withdrawals/invoices.

My Products

GibsonFit Online Monthly Training Product Image

GibsonFit Online Monthly TrainingINCLUDE: - CUSTOM WORKOUT PROGRAM ON TRUECOACH APP (IPHONE/ANDROID) - CUSTOM MACRO NUTRIENT ACCOUNT ON MYFITNESS PAL, - 24/7 SUPPORT - WEEKLY CHECKIN CALLS - FOOD AND SUPPLEMENT GUIDE

$300.00

Product NameINCLUDE: - CUSTOM WORKOUT PROGRAM ON TRUECOACH APP (IPHONE/ANDROID) - CUSTOM MACRO NUTRIENT ACCOUNT ON MYFITNESS PAL, - 24/7 SUPPORT - WEEKLY CHECKIN CALLS - FOOD AND SUPPLEMENT GUIDE

$150.00 Quantity

Enter coupon

Total

$0.00

How did you hear about me?*

FacebookInstagramFriend/FamilyOther
If other, please explain:
By signing below you acknowledge and agree to the terms and conditions outlined herein. You consent to participate in physical activities and exercises as prescribed by your personal trainer, understanding that there are inherent risks associated with physical activity, including but not limited to injury or health complications. You agree to hold harmless the trainer, their associates, and the company providing the service from any and all liability, claims, or damages that may arise during or after participation in the program.

Additionally, by subscribing to the service, you authorize the trainer or company to process A minimum 3 mandatory monthly withdrawals from your designated payment method for the duration of your membership, that is autorenewal. Monthly withdrawals will continue after 3 month minimum until a 30 day notice is received. At this time youll membership will be cancelled, and no other withdrawls will be conducted.

You agree to notify Owner/trainer Hunter Gibson 30 day notice of plan to cancel, and that if next payment is due you will be charged for that next month. You are responsible for ensuring your payment details are accurate and up to date. You may cancel your subscription at any time, subject to the terms of the cancellation policy. No results from this program, are promised or gaurenteed.

You agree to allow Owner/Trainer Hunter Gibson, GibsonFit Online Personal training, and other affiliated trainers to use transformation photos provided during your program(s), and duration of your membership/programs to be used for marketing, advertising on social media (Instagram,Facebook,etc).
I AGREE TO THE ABOVE TERMS & CONDITIONS!*

YesNo
Signature*

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Date*

MonthDayYear
Date
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