Personal Training Consultation Questionnaire

Full Name

First NameLast Name

Gender

MaleFemale

Date of Birth

MonthDayYear

Age

years

Height

cm

Weight

KG

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?

How often do you travel?

RarelyA few times a yearA few times a monthWeekly

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.

What additional therapies are being undertaken for the given health problem(s)?

If you have any injuries, please list them.

What additional therapies are being undertaken for the given injury?

Are you experiencing any stresses or motivational problems?

YesNo

Has anyone of your immediate family developed heart disease before the age of 60?

YesNo

Do any diseases run in your family?

YesNo

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

YesNo

Are you a current cigarette smoker?

YesNo

Your current diet could be best characterized as:

Please rate your readiness for change.

What following goals does best fit in with your goals?

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

How often are you willing to train a week to reach your goal?

Please rate your motivational level to do what it takes for reach your goal.

Are you currently excersising regulary (at least 3x per week)?

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

What are your expectations on me as your Personal Trainer?

1.) CANCELLATIONS

For Personal Training sessions, we require a 24-hour cancellation notice. Cancellations made with less than 24 hours' notice will be charged the full session fee. In case of unforeseen circumstances, please contact us as soon as possible to discuss rescheduling options.

For Monthly Classes, class credits must be used within the current month of purchase. Unused credits will not be carried over to the following month. Please note that class availability may vary, and early booking is recommended.

2.) LATE ARRIVALS

Each session shall be 45-minute / 1 hour in length (as per you have purchased). 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!

YesNo

Personal Training Consultation Form