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.
Required
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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