Personal Training Questionnaire
Please fill out this form to see if you’re a good match for FBM! 
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Email *
Full Name *
Email *
Phone Number *
Birthdate *
MM
/
DD
/
YYYY
Summary of your fitness goals *
What is your current fitness level? *
If you have one, please explain your current weekly workout routine. 
Are you training at the FBM facility or doing in-home personal training? *
If you chose “home” above, please list all exercise equipment you have.
What is your current occupation? *
Does your occupation require long periods of sitting? *
Does your occupation give you anxiety/high amounts of stress? *
Have you ever been told by a doctor not to participate in physical exercise/activity? *
If yes, why?
Please be as detailed as possible.
Do you take any medication? *
If yes, which medication(s)? 
Do you have any heart problems? *
Are you diabetic?  *
If yes, type I or II? 
Do you consume alcohol?  *
If yes, how often and how many alcoholic beverages? 
Please share any important medical history and/or medication I should be aware of.  *
Do you experience any bone/joint pain on a regular basis? *
If you said “yes” above, please specify where and what triggers such pain. 
Do you partake in any recreational activities (golf, swimming, gardening, etc.)? *
Do you have any food allergies? If so, please list them below.  *
Current Height and Weight *
Have you done a workout program before?  *
If yes, how well did you adhere to the program? Be honest. 
Not at all
90-100% Adherence
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Would you consider yourself a disciplined individual? *
Which days are you available for personal training? *
We will do our best to accommodate your schedule but cannot guarantee availability.
Required
Which time(s) of day is most ideal for you to meet for personal training?
We will do our best to accommodate your schedule but cannot guarantee availability.
Anything else you’d like me to know?
By choosing “yes”, you’re agreeing to the following:  I understand that participation in exercise/physical activity could include actions or tasks which might be hazardous to the participant. I assume any risk of harm or injury which might occur to me due to my participation in the event or activity. I release the trainer (Maryam Toor and all trainers of Fitness By Maryam) from all liability costs and damages which might arise from participation in the personal training program. I also agree to follow the program as recommended by my trainer and realize that failure to do so will negatively affect my results.   *
Is Fitness By Maryam allowed to use your before/after pictures publicly?  *
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