Client Consultation Form
Answer a few questions so I can understand your goals, health background, and training needs.
Full Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
What are your primary fitness goals?
*
Weight loss
Muscle gain
Improve flexibility
Increase endurance
General health
Other
Do you have any medical conditions or injuries?
*
No
Yes (please specify below)
If yes, please list your medical conditions or injuries
Are you currently taking any medications?
*
No
Yes (please specify below)
If yes, please list your medications
How would you describe your current physical activity level?
*
Sedentary (little or no exercise)
Lightly active (light exercise 1-3 days/week)
Moderately active (moderate exercise 3-5 days/week)
Very active (hard exercise 6-7 days/week)
Other
Do you have any exercise experience?
*
Beginner
Intermediate
Advanced
What types of exercise do you enjoy? (Select all that apply)
Cardio
Strength training
Yoga/Pilates
Group classes
Outdoor activities
Other
How many days per week would you like to train?
*
Please Select
1
2
3
4
5 or more
Do you smoke?
*
No
Yes
Do you consume alcohol?
*
No
Yes (please specify frequency below)
If yes, how often do you consume alcohol?
Do you have any food allergies or dietary restrictions?
*
No
Yes (please specify below)
If yes, please list your food allergies or restrictions
Is there anything else you would like your trainer to know?
Submit Consultation
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