Fitness Coaching Questionnaire

Part 1. Basic information
Personal Training Consultation Questionnaire
Full Name

First NameLast Name
Gender
Date of Birth

MonthDayYear
Age
years
Height
in
Weight
lbs
Phone Number

Area CodePhone Number
Email
example@example.com
How did you find out about my services?
Part 2. Lifestyle Information
What do you do for a living?
What's the activity level at your job?
Do you have a routine work schedule at regular working hours (9am-5pm)? If not, please describe your weekly work schedule.
How often do you travel?
Part 3. Medical and health information
If you have any diagnosed health problems, please list the condition(s).
If you have any injuries, please list them.
What additional therapies are being undertaken for the given injury?
Do you suffer from diabetes, asthma, high or low blood pressure?
if yes please list:
Are you a current cigarette smoker?
Do you drink alcohol?
If YES, how many glasses per week?
Part 4: Nutrition
On a scale of 1-10, how would you rate your nutrition (1 very poor, 10 excellent)?
Your current diet could be best characterized as:
Please describe your typical daily food intake.
How many times a day do you usually eat (including snacks)?
Do you skip meals?
Do you eat breakfast?
Do you eat late at night?
How much water do you drink a day?
Are you currently taking a multivitamin or any other food supplements? If so, please list them here. (brand specification is not necessary)
Part 5. Goals
How often do you take part in physical exercise?
If your participation is less than you would like for it to be, what are the reasons?
Please rate your readiness for change.
Please select all of the following that would best describe your fitness goals?
What is your biggest goal with your training?
Why?
What (if anything) has kept you from achieving your fitness goals in the past?

TImeline for achieving your goal.

Rows	8 WKS	16 WKS	24 WKS	32 WKS	40 WKS	1 YEAR
NOW

How often are you willing to train each week in order to attain your goals?
Please Choose
At what times during the day would you prefer to train?
Have you trained with a personal trainer or fitness coach before?
If yes, what kind of training did you do?
What are your expectations for me as your Fitness Coach?
When would you like to start your fitness program?
Please Read The Following Terms and Conditions.
1.) CANCELLATIONS

Cancellations should be made at least 24 hours in advance of a scheduled session. Sessions cancelled less than 24 hours in advance will be charged in full to the client.

2.) LATE ARRIVALS

Each session shall be 30 min to 1 hour in length. Sessions will not be extended (unless time is available) due to the lateness of the client or due to interruptions caused by the client.

3.) PAYMENTS

Client must pay for sessions at the first session of each week and pay for the entire week. Client has the option to pay monthly, or bi-weekly if they choose. If a session is missed due to clients schedule, there will be no refund for session.

3.) 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!
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Part 1. Basic information

Personal Training Consultation Questionnaire

Part 2. Lifestyle Information

Part 3. Medical and health information

Part 4: Nutrition

Part 5. Goals

Please Read The Following Terms and Conditions.