House of Sweat Personal Training Consultation Questionnaire

Full Name*

First NameLast Name

Gender*

MaleFemale

Date of Birth*

MonthDayYear

Age

years

Height*

Inches

Weight*

lb

Day Phone

Area CodePhone Number

Cell Phone

Area CodePhone Number

E-mail

What is the best way to make contact with you?

What do you do for a living?

Whats the activity level at your job?

none(seated only)Moderate (light activity such as walking)High (heavy labor, very active)

Do you follow a regular working schedule, do you work days, afternoon or nights?

How often do you travel?

RarelyA few times a yearA few times a monthWeekly

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

If you have any diagnosed health problems list the condition(s).

If you are on any medications, please list them.

What additional therapies are being undertaken for the given health problem(s)?

If you have any injuries, please list them.

What additional therapies are being undertaken for the given injury?

Are you experiencing any stresses or motivational problems?

YesNo

Has anyone of your immediate family developed heart disease before the age of 60?

YesNo

Do any diseases run in your family?

YesNo

Do you suffer from diabetes, asthma, high or low blood pressure?

YesNo

if yes please list:

Are you a current cigarette smoker?

YesNo

Your current diet could be best characterized as:

Which of the following goals best fit in with yours (select all that apply)?

Other fitness goals if not selected above:

What is your goal with your training?

Why?

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

How often are you willing to work with a trainer each week?

How often are you willing to workout by yourself a week given a specific plan to follow?

Describe the last time you participated in a structured exercise program:

What personal barriers do you feel are keeping you from reaching your nutritional and fitness goals?

Do you currently exercise on a regular basis?

YesNo

If yes, how many days a week?

How long is each session in minutes?

What equipment do you have access to?

What days are you available to train?

At what times during the day would you prefer to train?

MorningMid-DayAfternoonEvening

Have you trained with a personal trainer before?

YesNo

If yes, what kind of training did you do?

If yes, was your previous experience negative or positive? Why?

Describe your ideal personal trainer/What do you expect of me as your personal trainer?

Anthropometrics (Body measurements)

Chest*

Inches

Hips*

Inches

Lower Leg*

Inches

Neck*

Inches

Thigh*

Inches

Upper Arm*

Inches

Waist*

Inches

Average Daily Activity For The Day*

Explain how you believe your diet is affecting your health goals:

List your top 3 nutrition questions or goals:

Have you had any recent weight gain or loss?

YesNo

If yes, please explain:

Please rate your readiness for change.

Please rate your motivational level to do what it takes to reach your goal.

	1	2	3	4	5	6	7	8	9	10

1 is I have no motivation., 10 is I'll do anything it takes!

Describe something you are looking forward to in the near future:

How do you want to feel at this time?

How do you want what you are doing right now to influence this event?

What energizes you in the present? Think about a recent moment when you were happy! What was it about that moment that made it good for you?

What motivates you?

Need a strong motivator to push you to exerciseYou like to be informed about your program and how it is going to lead you to your goalsLike to try new things if they are effectiveWilling to push past your comfort level to reach your goalsf I feel things are really hard I tend to back offNeed to be held accountable for what I am doingBeing sore the day after a workout tells me my workouts are working

Commitment:

1.) CANCELLATIONS

The personal trainer reserves the right to charge you for a training session (or forfeit a session) if you do not give at least a 24-hour cancellation notice (unless directed otherwise and approved by trainer). This session will be classified as a "NO SHOW SESSION" and will be deducted from your session balance. If you will be running late for a session please give trainer a call or text 30 minutes prior to session or session will be subject to be rescheduled and or forfeited after 3 failed attempts. Any seessions that need to be made up will have to be made up within 30 days or they will be forfeited. A conversation with your trainer will be made in regards to dates, amount of sessions, and deadlines for sessions to be made up.

Communication is key!

Notes:

Trainer has the right to adjust schedules due to emergencies and or vacation times with notice. Trainee will still however be trained by another Push Universal Trainer or will be allowed to add sessions to their following week.

Payments are due monthly and to be paid in full. YOU ARE REQUIRED TO PAY FOR YOUR SESSIONS WHETHER YOU ATTEND THEM OR NOT MONTHLY. SIGNING THIS CONTRACT MEANS YOU UNDERSTAND THAT PAYMENTS ARE DUE ON TIME AND IN FULL REGARDLESS OF YOUR ATTENDANCE. YOU WILL HAVE TO SIGN A CARD AUTHORIZATION FORM. YOUR CARD MUST STAY ON FILE. FAILURE TO MAKE PAYMENTS AND REMOVAL OF CARD WILL RESULT IN POSSIBLE COURT ACTION AND CANCELLATION OF CONTRACT. If a contract is broken, there will be a fee discussed upon meeting with trainer. PAYMENT PLAN OPTIONS CAN AND WILL ONLY BE AWARDED TO THOSE RESPECTFUL OF H.O.S RULES AND REGULATIONS WITH PROPER COMMUNICATION AND POSSIBLE PROOF OF ABSENCE AND OR SHORTCOMINGS.
Please maintain communication with trainer.
Client may only increase session packages.
Children of trainees are allowed however trainees will be responsible for their children and or child. Ages 5 and up are premitted with possible $10 child fee through PushU.
Trainee understands that their results are a reflection of their work ethic.
Trainee will conduct themselves in a responsible and careful manner while training and respect the Push Universal Studio facility and its equipment.
Client will also honor all rules and regulations of the Push Universal contract while training.
Trainee agrees to train at Push Universal Studio.
Client has the right to stop any workout that causes them serious discomfort or pain to be modified or viewed by a doctor.
Trainees will workout in proper safe attire. No sandals or jeans will be approved for workouts.
Trainee understands that workouts will be designed to build up and some plans will look similar.
****Trainee understands that sessions can also be in GROUPS no more than 5-9 clients at a time. If trainee would like to be alone during trainer he or she is subject to a price increase but with a conversation with their trainer first.****
Trainer can cancel contract with trainee if trainer sees fit or feels as though they aren't a good fit. In this event trainer will complete sessions for the month paid for an cancel existing payments and training. Trainee can only cancel contract due to medical issues with a doctors note or relocating with proof of relocation.
Trainee understands that sessions should be booked a day (24 HOURS) in advance and that spacing is limited during certain times and availability depends on spacing. Failure to do so may result in client not getting certain time slots and will have to meet with trainer to discuss further action in their booking process.
Trainee understands trainer goes on break between 12-4pm daily. Please be courteous as to not book during these times and keep work conversation during normal work hours (no later than 8pm).
Trainer can cancel sessions due to dangerous or bad weather/climates to ensure the saftey of trainees and trainer.
Trainee contract can only be canceled only with a doctors note saying they cannot train due to sickness or injury and or client is relocating out of state with proof.
BUSINESS HOURS ARE MONDAY-THURSDAY 10-12/12:30 (BREAK 12-4) THEN RESUMES 4-7:30/8. (ONE ON ONE CLIENT HOURS START BTW 8 AND 9 AM).
ALL TRAINEES ARE EXPECTED TO KEEP UP WITH AND POST IN THE HOUSE OF SWEAT GROUP CHAT. UPDATES WILL BE GIVEN IN THE CHAT. NO EXCEPTIONS. PLEASE NOTE THAT IT IS MADE TO KEEP UP UPDATES, MEET OTHER MEMBERS, HOLD EACH OTHER ACCOUNTABLE, ETC. YOU CAN POST RECIPES, PICTURES, VIDEOS, MEAL PREPS, SWEATCHECKS, ETC. IT IS THE MOST EFFICIENT WAY TO COMMUNICATE WITH THE GROUP.
Trainee understands that rules are subject to change due to Covid and its restrictions.
Trainee understands the loyalty program is for clients that have been with H.O.S for a year consecutively.

2.) LATE ARRIVALS

Each session shall be 1-2 hours in length as initially agreed upon by the client and trainer. 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.) LIABILITY

In recognition of the possible dangers connected with any physical activity, the client hereby knowingly and voluntarily waives any right of cause of action of any kind whatosever arising from any liability which may or could accrue to the club, its officers, agent's employees or instructors.Should client default, client agrees to pay all costs of collection, including agency fees, court costs and reasonable attorney fees, all of which may be paid or incurred by the holder of this note. Client agrees that no other representation is made other than that which is agreed to in writing.

Failure to use all personal training sessions or follow program will not relieve client payment. If original trainer is unable to complete session (s), a trainer at Push Universal Studio has the right to assist in your training. No refunds will be given.

4.) 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 and conditions!*

Yes

Signature*

Date*

House of Sweat LLC "Home of the SweatCheck" Consultation Questionnaire

Part 1. Basic information

Part 2. Lifestyle Information

Part 3. Medical and health information

Part 4. Goals

Part 5. Nutritional Plan

Part 6. Mental Readiness/Personality

Part 7. Services Offered

Please Read The Following Reminders and Attachments