Personal Training Assessment Sign Up
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Email
*
First Name
Last Name
Phone Number
*
Gender
*
Male
Femaile
Age
Date Of Birth
Title
Height
Weight
If you have any injuries, please list them
If you have any diagnosed health problems list the condition (high blood pressure, etc)
What are your primary fitness goals?
Fat Loss
Muscle Tone
Lose Inches
Increase Strength
Increase Energy
Increase Confidence
Give us 2-3 body parts you specifically want to focus on?
On a scale of 1 to 10 (10 being the most serious) HOW SERIOUS ARE YOU ABOUT ACCOMPLISHING YOUR FITNESS GOALS?
How long have you been thinking about accomplishing your fitness goals?
What has stopped you in the past?
How often are you willing to train per week to reach your goal?
Is your job active or sedentary
Sedentary
Active
Have you ever worked with a personal trainer before?
Yes
No
What are the things that we can help you out with in order to make sure that you are successful?
Variety
Nutrition
Structure
Accountability
At what times during the day would you prefer to train?
Morning
Mid-Day
Afternoon
Evening
How many meals are you eating daily?
1
2
3
4
5
5+
How many times per day are you currently eating out?
1
2
3
4
What specific events are coming up in the next year to help us motivate you to reach your goals?
What are your expectations on me as your Personal Trainer?
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