Personal Training Questionnaire

Full Name*

First NameLast Name

Gender*

MaleFemale

Date of Birth*

MonthDayYear

Age*

years

Email*

example@example.com

Phone Number*

Area CodePhone Number

Height*

cm

Weight*

KG

What are the three most important things/aspects to you in your life at this present time?

What are your objectives? What do you honestly want to get out of the program in the next month?

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.:*

What other hobbies or activities do you partake on a regular basis?*

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

If yes please list:

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

YesNo

If yes please list:

Are you a current cigarette smoker?*

YesNo

Your current diet could be best characterised as:*

Please state your dietary requirements? (eg any foods you can't/will not eat)*

How many meals per day do you currently eat on average?*

Do you eat very similar meals each day or are they more varied/erratic: eg. bought packaged goods etc... (please expand)*

Choose a standard day to record what you eat and drink. This MUST be precise; for example, record the time meals or drinks are consumed, and even the amount of sugar you put into your coffee etc. This must also be a day that will honestly reflect what your typical food/drink consumption is. Please be honest, this is a judgement free zone

Have you tried any diets?

YesNo

If yes, for each one please let me know your specific reason for doing it and how long you tried/stayed on it. Also, include if there was anything you enjoyed about them or disliked about them.

Please rate your readiness for change.*

What are your goals? (Please number goals in order of importance, 1 being most important)*

	1	2	3	4	5
Lose body fat
Build muscle
Get stronger
Get fitter
Performance based
Other

Please expand on your goals (Quantifying your targets, expectations, timescales, previous experiences)*

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?*

Are you training in a gym?*

YesNo

If no, would you be willing to train in a gym?*

YesNo

Tell me: of any unavailability, sporting commitments, gym access, etc.*

Do you have access to any equipment at home?*

YesNo

If yes, what equipment do you have?*

What is your current level of activity/fitness level?*

What exercises/activities you dislike?*

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

Are you currently exercising regularly?*

YesNo

If yes, how often are you training per week?*

Have you trained with a personal trainer before?*

YesNo

If yes what kind of training did you do:*

Have you worked with an online coach before?*

YesNo

I confirm I am happy to subscribe to emails and communication from Vee Fitness with nutrition tips and workouts.*

YesNo