Personal Training Intake Form
It will take about 20 minutes to complete this form. Please allow 24 hours for us to get back with you.
Email address *
PERSONAL INFORMATION
Tell us more about yourself.
Name/DOB
Your answer
Phone number
Your answer
Why do you want personal training?
Your answer
What is your primary goal?
Your answer
Lifestyle Questions
Do you smoke?
Your answer
Do you drink alcohol?
Your answer
How many hours of do you sleep at night?
Your answer
How many hours do you sit during the day on average?
Your answer
Rate your current stress level
low
high
What are your 3 largest sources of stress?
Your answer
Does your job require you to travel?
Does your job require you to travel?
Is anyone in your family overweight?
Fitness Program Development Questions
How many days a week and how long do you participate in exercise?
Your answer
If your participation is lower than you like, why is it this way?
Your answer
What physical activities or exercises are you currently involved in?
Your answer
What do you need the most help with?
Your answer
How often would you like to exercise
What would you ultimately like to learn from a trainer during your sessions?
Your answer
Where does health rank with your spouse/significant other/family?
low
high
What do you think a trainer can do, to help you accomplish your goals?
Your answer
Nutrition Questions
Rate your current nutrition status
poor
excellent
How much water do you drink during the day?
Your answer
Do you count calories?
Have you ever tracked your food?
Do you cook and grocery shop for your household?
Is most of your food freshly prepared, or processed?
Your answer
What are 3 areas in your nutrition your would like to see positive changes?
Your answer
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