Personal Training Client Questionnaire Form

Please fill out this form as completely as possible. If you are unsure of an answer, please ask your trainer for clarifications.

PERSONAL INFORMATION:

Name: _______________________________________ Age: _______ Date of Birth: ________________

Phone Number: ____________________ Email address: ________________________________

Preferred method of contact: Email ___ Phone ___ Either ___

YES / NO Have you had a personal training previously?

If so, when and for how long? ________________________________________________

What did you like about it? __________________________________________________

YES / NO Are you currently involved in regular cardiovascular exercise?

YES / NO Are you currently involved in regular strength building exercise?

If yes, how long have you been exercising regularly? ___-____________________________

What other sports/exercises/recreational activities do you currently participate in?

_______________________________________________________________________________________

Length of time you have done so? _____________________ Frequency? ___________________

AVAILABILITY:

When would you be able to work with a trainer?

Weekday mornings_____ Weekday evenings _____ Weekday afternoons_____ Weekends _____

Smoker: Yes/No

Describe your lifestyle: Sedentary____ Lightly Active____ Moderately Active____ Highly Active____

FITNESS GOALS

What are your fitness goals? Please rank the following 1 through 10:

(1 = not important at all, 10 = extremely important)

Is there any other information that we need to know before scheduling your appointment? (Medical conditions,

previous injuries/old sports injuries, medications currently taking):

Why do you want to do this now?

____________________________________________________________________________________

Signature: ________________________________________________ Date: ______ /______ /________