Personal Training Questionnaire
FOR INDIVIDUALS READY TO MAKE A CHANGE
Email Address
*
Full Name
*
Age
*
Gender
*
Male
Female
Weight
*
Height
*
Whats your activity level?
None
Moderate (light activity such as walking)
High (heavy labor, very active)
Other
Please list the physical activities that you participate in outside of working out and outside of work.:
*
If you have any injuries or have in the past, please list them. Put N/A if not applicable
*
Are you experiencing any stresses or motivational problems?
Yes
No
if yes please list:
Your current diet could be best characterized as:
*
low-fat
low-carb
high-protein
Vegetarian/Vegan
No special diet
Please rate your readiness for change.
*
1
2
3
4
5
6
7
8
9
10
What following goals does best fit in with your goals?
*
Improved health
Improved endurance
Increased strength
Increased muscle mass
Fat loss
Other
What is your goal with your training?
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