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Pre-Training Information Form- Wellness and Recreation Services
Email address *
Current Date *
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Name *
Your answer
Address
Your answer
Phone Number *
Your answer
Age *
Your answer
Date of Birth *
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DD
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YYYY
How are you associated with UNI? *
Do you prefer a male or female trainer? *
Best days for exercise
What times during the day are you available to train? (generally) *
Your answer
What are your main goals from exercise?
Your answer
What do you want from your personal trainer?
Your answer
Are you currently involved in a consistent exercise regimen?
Frequency of exercise (times per week)
Your answer
Duration (average time of exercise session)
Your answer
Intensity of current exercise program (if applicable, 1being the lowest and 5 highest)
How long have you been exercising regularly ?
Characterize your present athletic ability (1 lowest, 5 highest)
Characterize your present muscular strength (1 lowest, 5 highest)
Characterize your present cardiovascular condition (1 lowest, 5 highest)
Characterize your present flexibility (1 lowest, 5 highest)
Exercise Preferences
How many days per week are you willing to devote to an exercise program?
Your answer
How many minutes per day are you willing to devote to an exercise program?
Your answer
What types of exercise interest you? Check all that apply?
Exercise Goals
Desire to improve rated from 1 (lowest) to 5 (highest)
Improve cardiovascular fitness
Improve flexibility
Increase muscular strength
Increase energy level
Reduce stress/Improve mood
Improve performance in a specific sport
Lose weight
Gain muscle mass
Improve diet/eating habits
Enjoyment in being physically fit
Other
Your answer
Past Training Experience
Have you ever joined an organized physical activity program before?
What activity and how long did you stay with it?
Your answer
Have you even been injured participating in any physical activity?
Explain your injury.
Your answer
What type of work do you do?
Your answer
Explain any physical activity on the job.
Your answer
How stressful is your job/school?
Do you sleep well?
Do you relax easily?
What do you do to relax?
Your answer
Any current injuries or conditions that would inhibit exercise?
Your answer
Do you prefer 30 minute or hour long sessions? *Please keep in mind half hour sessions only receive 80% of total time purchased
What personal training session package would you be interested in?
How did you hear about the UNI personal training program?
If other, please explain.
Your answer
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