PERSONAL TRAINING CLIENT FORM

All about you

confidential
Full name*

First NameLast Name
E-mail*
example@example.com
Mobile number
Date of Birth

MonthDayYear
Date
Height (cm)
Current weight? kg (morning, before food or drink)
Emergency contact*

First NameLast Name
Diet and nutrition

I am here to help :)
Let me know your favourite ingredients (try to include proteins, carbs, and treats and give me as much as you like)
Let me know your dislikes of ingredients (give me as much as you can)
If you have allergies, restrictions or intolerances please share below
I can just about make toast.I follow recipes like IKEA instructions — something’s always missing.I can cook… if “cook” means throwing sauce on something beige.I’m the family chef — people come running when they smell garlic.I could host MasterChef (and still complain about the plating).
Training and exercise experience

Let me know anything that you think will be relevant to your training
If you are currently exercising or training let me know all about (exercises, frequency, volume, etc)
Let me know of any experience of exercise in your recent past
What are your goals?

I will get you there
Where would you like to be in 12 weeks, physically & mentally? Please be as specific as you can be. ie; to lose 5kg in 12 weeks or to run 5k in under 30 minutes.
What are your longer term aspirations? Again be specific. ie; to lose 10kg in a year or to be able to play 90 minutes of 11-a-side football again.
Health questionnaire (Par-Q)

The questions below are a legal requirement before we can start training together
Common sense is your best guide when you answer this questionnaire. Please read the questions carefully and answer each one honestly: check YES or NO.

Par-Q*

Rows	Yes	No
Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?
Do you feel pain in your chest when you do physical activity?
In the past month, have you had chest pain when you were not doing physical activity?
Do you lose balance because of dizziness or do you ever lose consciousness?
Do you have bone or joint problem (for example, back, knee, or hip) that could be worsen by a change in your physical activity?
Is your doctor currently prescribing drugs (for example water pills) for your blood pressure or heart condition?
Do you know of any other reason why you should not do physical activity?
Are you pregnant or have you given birth in the last 6 months?
Do you have diabetes, asthma, or any long-term condition?
Do you have any allergies or intolerances (for nutrition planning)?
“I have answered the above questions accurately to the best of my knowledge. I understand that it is my responsibility to inform my trainer of any changes to my health.”

Initials*

Clear
Should be Empty:

All about you

Diet and nutrition

Training and exercise experience

What are your goals?

Health questionnaire (Par-Q)