Impackt Fitness New Client Questionnaire

1

For hybrid or online coaching inquiry

2

Full Name* This field is required.

First Name

Last Name

3

Gender

Male

Female

4

Date of Birth

5

Mailing Address

Street, City, State, Zip

6

Contact number* This field is required.

7

Email Address* This field is required.

8

What do you do for a living?

9

Whats the activity level at your job?

none(seated only)

Moderate (light activity such as walking)

High (heavy labor, very active)

10

What are some of your hobbies? (reading, gardening etc)

11

Please list the physical activities that you participate in outside of the gym and outside of work.:

12

How many hours of sleep do you get per day?

14

Are you experiencing any stresses or motivational problems?

Yes

No

15

Are you a current cigarette smoker?

Yes

No

16

What is your specific goal with your training?

17

What are your top 3 fitness goals?

20

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

22

Are you currently exercising regularly (at least 3x per week)?

Yes

No

23

Have you trained with a personal trainer before?

Yes

No

24

If yes, what kind of training did you do? Tell me about that experience

25

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

Please Choose

26

What are your expectations of me as your Personal Trainer?

27

How did you hear about ImPACKt Finess?* This field is required.

28

When is the best time to reach you by phone?

29

I have answered all questions honestly and to the best of my knowledge. By submitting, I opt in to also recieve periodic fitness and nutrition tips.

30

I AGREE TO THE ABOVE STATEMENT* This field is required.

Yes

No