Personal Training Consultation Questionnaire

Full Name *

First Name Last Name
Gender

Male Female
Email
example@example.com
Date of Birth *

Month Day Year
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?

Rarely A few times a year A few times a month Weekly
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.
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?

Yes No
Has anyone of your immediate family developed heart disease before the age of 60?

Yes No
Do you suffer from diabetes, asthma, high or low blood pressure?

Yes No
if yes please list:
Are you a current cigarette smoker?

Yes No
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
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.

1 2 3 4 5 6 7 8 9 10
Are you currently excersising regulary (at least 3x per week)?

Yes No
Have you trained with a personal trainer before?

Yes No
If yes what kind of training did you do:
At what times during the day would you prefer to train?

Morning Mid-Day Afternoon Evening
How often do you want to do Personal Training a week?
Please Choose
What are your expectations on me as your Personal Trainer?
When is the best day and time to arrange a call?
Date

Month Day Year
Date Date Picker Icon
Time

: Hour Minutes AM/PM Option
Should be Empty:

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