Personal Training Consultation

Full Name*

First NameLast Name
MaleFemale
Date of Birth*

MonthDayYear
Age
years
Height
FT.IN
Weight
LB
Email
LB
Phone #
LB
Instagram
LB
What do you do for a living?
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?
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.
If you have any injuries, please list them.
YesNo
YesNo
if yes please list:
low-fatlow-carbhigh-proteinVegetarian/VeganNo special diet
12345
Improved healthImproved enduranceIncreased strengthIncreased muscle massFat loss

TImeline for achieving your goal.

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

What are your expectations on me as your Personal Trainer?
If I gave you a plan to follow would you be able to spend 3 hours per week working on it to achieve the results you want
How often are you willing to train a week to reach your goal?
YesNo
YesNo
YesNo
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