Personal Training Consultation Questionnaire

Full Name

First NameLast Name

Gender

Date of Birth

MonthDayYear

Height

feet/inches

Weight

LBS

Phone Number

Email

Social Media: Instagram/Facebook link or name.

How Did you hear about TJTemperTraining?

Do you have any diagnosed health problems or injuries list the condition(s).

What is your Goal? Lose 10lbs, Gain 10lbs of muscle, Look good, feel better, Have more energy? Please be specific. Does not have to be a physical goal.

What's stopping you from hitting your goals?

Are you experiencing any stresses or motivational problems?

if yes please list:

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

if yes please list:

Your current diet could be best characterized as:

Please rate your readiness for change.

What following goals best fit in with your goals?

TImeline for achieving your goal.

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

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

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

Have you trained with a personal trainer before?

If yes what kind of training did you do:

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

How often do you want to do Personal Training a week?

Please Choose

Do you have family and friends that support you ( Meaning they will give you a thumbs up on whatever you decide)?

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