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First name
*
Last name
*
Email
*
Phone
*
Birthday
*
Month
Month
Day
Year
Goals
Balance and Stability
General Strength and Endurance
Grow Muscles or Bodybuilding
Maximum Strength - Lift as much as you can
Become Powerful - Speed and Strength
Better nutrition habits and fat loss
What level of experience do you have with working out
None
Some
A lot
What daily activities do you do? (Gardening/ biking/painting/housekeeping/stairclimbing)
What level of involvement would an ideal fitness instructor have in your fitness program?
Do you smoke? If yes, how much and often?
Do you drink alcohol? How much/often?
Have you had any notable injuries that should be considered?
Brain
Muscular
Bones
Joints (ligaments and tendons)
Other
What services most interest you?
Program Design
Working out together/accountability
In Person Training
Online Training
Nutrition Coaching
What days are best for you to workout?
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
What worked and what didn't work in previous exercise program attempts?
How willing are you to stay consistent when you are on your own?
Very Willing
I'll do what I can
I need my personal trainer to be there for me most of the time
I need my personal trainer to be there always
Other
What activities do you want most in your workout plan?
Cardio
Weight Lifting
At home workouts
Bodyweight exercises
Stretching
Foam Rolling
Speed/Agility/Quickness drills
Running routine
Core/Balance/Plyometric
Recovery Techniques
Balance and stability exercises
What do you think is the most important thing your personal trainer can do to help you achieve your fitness goals?
Feel Free to add any details that you feel are pertinent to your lifestyle or to the type of personal training experience you would like to have.
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