Personal Training Consultation Questionnaire

Personal Training Consultation Questionnaire

Thank you so much for your interest in personal training, please take your time to fill out the following information so that I can best help you reach your goals!!
Full Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Gender
Date of Birth

MonthDayYear
Height
Weight
LBS
Whats the activity level at your job?
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.
Has anyone of your immediate family developed heart disease before the age of 60?
Do any diseases run in your family?
Do you suffer from diabetes, asthma, high or low blood pressure?
Please list:
Are you a current cigarette smoker?
Your current diet could be best characterized as:
What following goals does best fit in with your goals?
Why are these goals important to you?
How many days a week are you able to dedicate towards your goals?
Please rate your motivational level to do what it takes for reach your goal. (1 being least motivated & 10 being highly motivated)
How often do you want to do Personal Training a week?
Please Choose
What are your expectations on me as your Personal Trainer?
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 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.) 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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