Personal Training Client Screening Form

Personal Training - Client Health & Lifestyle Questionnaire (In-person, Varna)

Hey mumma, Please take your time — all information is kept strictly confidential, and stored securely. If you are unsure about any question, leave it blank or select 'Prefer not to say'. And we can circle back to it on our first meeting
1. Choose the pricing option that fits you best, Packages are paid monthly
2. Full Name

First NameLast Name
3. Weight in kg
4. Height in cm
5. Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
6. Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
7. Email Address
example@example.com
8. What is your occupation/daily role?
A stay at home mum is an occupation;)
9. How did you hear about Abi's Personal Training?
2. General Health

The following questions help me ensure your programme is safe and appropriate for you. Please answer as honestly as possible.
1. Has a doctor ever told you that you have a heart condition or high blood pressure?
2. Do you experience chest pain, dizziness, or shortness of breath during physical activity?
3. Do you have any bone, joint, or muscle problems that could be made worse by exercise?
4. Have you had any surgery in the past 12 months?
5. If yes to surgery, please describe:
6. Are you currently taking any prescribed medication?
7. If yes to medication, please list them:
8. Do you have any diagnosed medical conditions we should be aware of?
9. Have you ever been told by a medical professional to avoid or restrict certain types of exercise?
10. If yes, please describe:
11. When did you last see a GP or healthcare professional?
3. Injuries & Pain
1. Do you have any current injuries?
2. If yes, please describe the location and severity:
3. Do you experience chronic or recurring pain?
4. If yes, where, how long for and how often?
5. Have you ever had a prolapse diagnosis or symptoms?
6. Have you been assessed for diastasis recti (abdominal separation)?
7. If assessed, what was the outcome?
8. Do you experience any dysfunctional pelvic floor symptoms?
9. Are you currently seeing a physiotherapist or massage therapist?
4. Fitness & Activity History
1. How would you describe your current activity level?
2. What types of exercise have you done before and enjoyed?

Other
3. How long have you been exercising regularly?
4. What are your main fitness goals? You can select multiple
5. Is there anything specific you want to avoid or that you are nervous about?
6. What does success look like to you in 3 months?
5. Sleep & Rest
1. On average, how many hours of sleep do you get per night? (even if its broken sleep, only count the time you are asleep)
2. How would you rate your sleep quality overall?
3. Do you have trouble falling or staying asleep?
4. Do you feel well rested when you wake up?
5. Are there any factors currently disrupting your sleep?

Other
6. Nutrition & Hydration
1. How would you describe your current eating habits?
2. Do you follow any specific diet or have any dietary restrictions?
3. How many meals or snacks do you typically eat per day?
4. How much water do you drink per day?
5. Do you feel your energy levels are affected by what you eat?
6. Are there any nutritional concerns or goals you would like to discuss?
7. Mood & Mental Wellbeing

I understand that wellbeing is about far more than physical fitness. These questions help us tailor your programme to support your whole self. You are not required to share anything you are not comfortable with.
1. Over the past two weeks, how often have you felt down, anxious, or overwhelmed?
2. How would you rate your overall mood and emotional wellbeing right now?
3. How well are you managing stress in your daily life?
4. Do you have a support network around you such as friends, family, a partner, or community?
5. Is there anything about your mental or emotional wellbeing you would like your trainer to be aware of?
8. Lifestyle & Daily Habits
1. How would you describe your stress levels day to day?
2. How much of your day is spent sitting or sedentary?
3. Do you smoke or use nicotine products?
4. How often do you consume alcohol?
5. Do you have regular childcare or support that allows you to attend child-free gym floor sessions?
6. Where would you prefer the sessions to take place?
7. What time of day suits you best for training?
9. Pregnancy & Postnatal Health

This section is for clients who are currently pregnant or have been pregnant before. If this does not apply to you, please skip ahead to the final section — nothing here is required.
1. Does this section apply to you?
2. Are you currently pregnant?
3. If currently pregnant – how many weeks pregnant are you?
4. Has your midwife or doctor confirmed this is a low-risk pregnancy?
5. Have you received clearance from your midwife or GP to exercise?
6. Have you experienced any complications in this or a previous pregnancy?
7. How many children do you have?
8. How were your baby or babies born?
9. How long ago was your most recent birth?
10. Have you had your 6-week postnatal GP check?
11. Are you currently breastfeeding? Includes pumping
12. Did you experience any of the following during pregnancy or postpartum?
13. Have you been seen by a women's health physiotherapist postnatally?
14. Is there anything else about your pregnancy or postnatal journey you would like your trainer to know?
10. Consent & Final summary
1. How excited are you to get started?
2. What types of exercise do you enjoy the most?
3. What are your struggling most with right now?
4. How many years or months have you been struggling with this problem?
5. What routines or diet have you tried to tackle this issue?
6. What made you reach out for help?
Thank you for filling in this questionnaire.

Your answers will be used to create a personalized fitness programme. With your adherence and our coaches' dedication, the results are DEFINITE.

After you submit the form, our coach will be in contact with you within the first 24 hours; your programme will be available from 3 days after the first contact
Should be Empty:

Personal Training - Client Health & Lifestyle Questionnaire (In-person, Varna)

2. General Health

3. Injuries & Pain

4. Fitness & Activity History

5. Sleep & Rest

6. Nutrition & Hydration

7. Mood & Mental Wellbeing

8. Lifestyle & Daily Habits

9. Pregnancy & Postnatal Health

10. Consent & Final summary