Clone of Personal Training Questionnaire

1
My coaching is personalized, structured, and designed to help women stay consistent with their health, fitness, and overall well-being. This is not a traditional gym or drop-in workout program — it’s a coaching relationship focused on accountability, support, and long-term results. This questionnaire helps me understand your goals, lifestyle, and what you’re looking for so we can make the most of your consultation. Coaching program investments start at $299/month and all pricing will be displayed at on the enrollment section. You are filling out this questionnaire based on your knowledge of the programs, the pricing, and your readiness to get started!* This field is required.
YESNO
2
Name* This field is required.
First Name
Last Name
3
Address* This field is required.
Street Address
Street Address Line 2
City
State
Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
4
Email* This field is required.
example@example.com
5
Phone Number* This field is required.
Area Code
Phone Number
6
Preferred method of communication
Please Select
Please Select
Phone call
Text messaging
Email
Phone call or Text
No preferred method
7
How did you hear about me?* This field is required.
8
What is your current age?
9
What does a typical day look like for you?
Huge
Large
Normal
Small
Ok
Ok
10
How active are you right now?
Please Select
Please Select
Not very active
Some activity
Consistently active
11
What is your primary goal right now?
12
If you could change 1-2 things about your health or body, what would they be?
Huge
Large
Normal
Small
Ok
Ok
13
Have you tried working on this before? If so, what worked? What didn?
Huge
Large
Normal
Small
Ok
Ok
14
A little more context so I can support you well…
15
Do you have any joint pains, aches, joint injuries, or limitations or any other medical condition that may affect your exercise program?
Huge
Large
Normal
Small
Ok
Ok
16
Right now, are you taking any medications, either over-the-counter or prescription? Please list the medication and what it is for.
Huge
Large
Normal
Small
Ok
Ok
17
Have you been advised by a doctor to modify exercise or nutrition?Please explain below
Huge
Large
Normal
Small
Ok
Ok
18
What does a typical day of eating look like for you?
Huge
Large
Normal
Small
Ok
Ok
19
Where do you feel your nutrition is the strongest?
20
Where do you feel it needs the most work?
21
Let's talk about what's been challenging...
22
What feels hardest about your health or fitness right now?
Huge
Large
Normal
Small
Ok
Ok
23
How has this been affecting your day-to-day life?
Huge
Large
Normal
Small
Ok
Ok
24
When do you notice this bothering you the most?
Huge
Large
Normal
Small
Ok
Ok
25
What has been the most frustrating or discouraging part of this for you?
Huge
Large
Normal
Small
Ok
Ok
26
How does this make you feel about yourself?
27
Looking ahead for a moment...
28
If nothing changes, where do you see yourself 6–12 months from now?
Huge
Large
Normal
Small
Ok
Ok
29
What concerns you most about continuing on your current path?
Huge
Large
Normal
Small
Ok
Ok
30
Now let's flip that...
31
If we fast-forward 6 months and things are going well, what would be different?
Huge
Large
Normal
Small
Ok
Ok
32
What would success look like in your real life (not just on the scale)?
Huge
Large
Normal
Small
Ok
Ok
33
What would that allow you to do that you can’t fully do right now?
Huge
Large
Normal
Small
Ok
Ok
34
A couple final questions...
35
Why is now the right time for you to focus on this?
36
What made you fill this out today instead of waiting?
37
On a scale of 1–10, how ready are you to make changes?
38
Why did you choose that number?
39
What kind of support are you looking for right now?Ex: structure, accountability, workouts, nutrition, all of it, etc
40
Is there anything else you want me to know before we begin?
Huge
Large
Normal
Small
Ok
Ok
41
Thank you for taking the time to complete this questionnaire. I’ll review your responses before we connect so I can understand your situation and what you’re looking to improve. I’ll reach out as soon as possible to schedule your consult. If you need to get in touch in the meantime, you can contact me at 320.304.9153 or makefitnessfun4you@gmail.com

I look forward to meeting you!

Nicole Pomerenke
Should be Empty: