Personal Training Consultation Questionnaire

Full Name

First NameLast Name

Gender

Date of Birth

MonthDayYear

Age

years

Height

cm

Weight

KG

What do you do for a living?

What's the activity level at your job?

Do you follow a regular working schedule, do you work days, afternoon or nights?

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 a current cigarette smoker?

What following goals does best fit in with your goals?

What is your goal with your training?

How often are you willing to train a week to reach your goal?

Please rate your motivational level to do what it takes for reach your goal.

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

At what times during the day would you prefer to train?

How often do you want to do Personal Training a week?

Please Choose

ALL THE INFORMATION I HAVE GIVEN IS CORRECT

All the information on this form is correct and to the best of my knowledge. I have sought and followed any necessary medical advice. I understand that all the information given will be kept confidential.

I AGREE TO THE ABOVE TERMS & CONDITIONS!