Dani K Mobile Consultation Form

Dani K Mobile Consultation Form

Please fill in all the details and I look forward to getting started!
Full Name*

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Gender

MaleFemale
Date of Birth*

MonthDayYear
Age
years
Height
ft
Weight
If unknown that's okay
Phone Number

Area CodePhone Number
Email
How do you prefer to be contacted?
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?
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.
Are you experiencing any stresses or motivational problems?

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

YesNo
if yes please list:
Are you a current cigarette smoker?

YesNo
Please rate your readiness for change.

12345678910
What following goals does best fit in with your goals?

Improved HealthTone UpIncreased StrengthIncreased Muscle MassFat LossWeight GainBuild Gym Confidence
What is your goal with your training?
Why?

TImeline for achieving your goal.

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

Are you currently excersising?

YesNo
Have you trained with a personal trainer before?

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

MorningMid-DayAfternoonEvening
How often do you want to do Personal Training a week?
Please Choose
Is it okay to post photos and videos to social media of training and/or progress photos?

YesNoOnly TrainingOnly Progress
Are you okay with Progress Photos (taken personally)?

YesOnly for PT to seeOnly for personal trackingNo
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. 4. If the trainer shows up late, the training session will go the full hour from his/her late arrival start time.
I AGREE TO THE ABOVE TERMS & CONDITIONS!*

YesNo
Phone Number

Area CodePhone Number
Should be Empty: