Active with Alana – In-Depth Client Consultation & Pre-Screening Form
Please answer each question as thoroughly as possible. This helps us create a safe, effective, and personalised program.
PERSONAL DETAILS
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Date Of Birth
Age
GOALS & MOTIVATION
What are your top 3 fitness goals, and why are they important to you?
What is your desired timeline for achieving these goals?
What has been your biggest barrier to reaching your fitness goals in the past?
How will you know you have successfully achieved your goals (e.g., changes in body composition, strength, confidence, energy, health markers)?
Why do you want to work with Active with Alana? Please explain your motivation in detail, including what has inspired you to start now:
What services or expectations do you have from Active with Alana (e.g., training style, support, accountability, progress tracking, nutrition guidance)?
TRAINING & EXERCISE HISTORY
Tick your previous experience in the gym?
Beginner
Intermediate
Advanced
Where will you be training? (Gym / Home / Both)
What best describes your current training goal?
Strength & weight training (with endurance included)
Balanced strength & cardio
Predominantly cardio-based fitness
Are there any types of training you particularly enjoy or dislike?
Have you worked with a personal trainer or coach before? Yes / No - If yes, what did you like and dislike about that experience?
How long have you been consistently exercising?
What types of exercise do you currently do (strength, cardio, Pilates, yoga, classes, sports)? Please detail frequency, intensity, and duration:
Are there any exercises, movements, or equipment you cannot perform or feel uncomfortable doing? Please explain:
What has been your biggest challenge with training so far (motivation, consistency, technique, injuries)?
On a scale of 1–10, how would you rate your overall fitness level?
NUTRITION
Describe your typical daily meals and snacks, including portions and timing:
Do you follow any specific dietary restrictions or preferences (e.g., vegan, keto, dairy-free)?
How much water do you drink per day?
Do you take any supplements or vitamins? Please list and describe purpose:
Are there foods you avoid or dislike? Please explain:
Which approach do you feel would support you best right now?
Structured tracking (calories/macros) for awareness and guidance
Intuitive eating, focusing on habits, hunger cues, and consistency
Have you tracked food before? If yes, what was that experience like?
LIFESTYLE & DAILY HABITS
Describe your typical day from waking to sleeping, including activity levels, work, commuting, and downtime:
How many hours per day do you typically sit or remain inactive?
What are your hobbies, sports, or leisure activities?
How many hours per week are you realistically able to dedicate to training and preparation (including workouts, prep, recovery)?
Are there any potential obstacles that could affect your consistency (work schedule, family, travel, health)? Please explain:
COMMITMENT & READINESS
On a scale of 1–10, how committed are you to following a program, nutrition guidance, and lifestyle changes?
Are you willing to track progress and complete check-ins consistently? Yes / No
Are you ready to invest time, effort, and energy to achieve your goals? Yes / No
What motivates you most to stick with a program long-term?
EXPECTATIONS & ADDITIONAL NOTES
What are your expectations of your trainer and the coaching process?
Is there anything else your trainer should know to personalize your program effectively?
Any questions, concerns, or comments you would like to share?
HEALTH & MEDICAL HISTORY
Medical Conditions & Injuries
Do you have any chronic illnesses (e.g., diabetes, heart conditions, asthma)? Please explain severity and any current treatments:
Do you currently have any injuries, past injuries, or surgeries that might affect your training? Please provide dates and details:
Are you currently taking medications or supplements? If yes, list them and their purpose:
Do you have any allergies (food, environmental, etc.)? Please describe severity and reactions:
Have you ever been advised by a medical professional to avoid certain exercises or physical activities? Please describe:
Have you had surgery in the past 2 years? Please provide details:
Are there any other health or medical concerns we should be aware of?
Lifestyle & Health Habits
Do you smoke or use nicotine products? Yes / No (If yes, how often?)
How much alcohol do you consume weekly? Please specify type and frequency
How many hours of sleep do you get per night on average?
How would you describe your stress levels on a scale from 1–10?
Do you have any other habits that may impact training or recovery (e.g., high caffeine intake, shift work, frequent travel)?
CONSENT
I hereby confirm that the information I have provided is accurate and truthful to the best of my knowledge. I understand that my trainer will use this information to design a program suited to my individual needs.
Signature
Date
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Month
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Day
Year
Date
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