Personal Training Consultation Questionnaire

PD Training Consult Form
Full Name

First NameLast Name
MaleFemale
Date of Birth

MonthDayYear
Age
years
Height
cm
Weight
KG
What do you do for a living?
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?
RarelyA few times a yearA few times a monthWeekly
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?
YesNo
YesNo
YesNo
YesNo
Please list:
YesNo
Low-fatLow-carbHigh-proteinVegetarian/VeganNo special diet
12345678910
Improved healthImproved enduranceIncreased strengthIncreased muscle massFat loss
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

PD Training Consult Form