Personal Training Questionnaire
Please complete the questionnaire below to book your Trial Personal Training Session. We'll be in touch within 24 hours to confirm the details for your session.
Email address *
Personal Details
Title *
Your answer
Full Name *
Your answer
Postcode *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Sex *
Telephone Number *
Your answer
Your Trial Personal Training Session
Please select the time slots you're available for your Trial Personal Training Session
7AM-10AM
10AM-1PM
1PM-4PM
4PM-7PM
7PM-10PM
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Would you like to experience personal training at your home or another location? *
If you selected "Another location" above please provide the postcode and a short description of the location you would like your personal training session to take place. If you would like us to select an outdoor location for you, please write "You decide".
Your answer
Do you have any exercise equipment at home? If yes, please provide the type of equipment and the weight if applicable. *
Your answer
Par-Q
(Physical Activity Readiness Questionnaire)
1. Has your Doctor ever said you have a heart condition and you should only perform physical activity recommended by a Doctor? *
2. Do you feel pain in your chest when you do physical activity? *
3. In the past month have you had chest pain when you were not doing physical activity? *
4. Do you lose your balance because of dizziness, or do you ever lose consciousness? *
5. Do you have a bone or joint problem (for example, back, knee or hip) that could be made worse by a change in your physical activity? *
6. Is your doctor currently prescribing medication (for example, water pills) for your blood pressure or heart condition? *
7. Do you know any other reason why you should not do physical activity? *
Disclaimer
If you have answered “Yes” to one or more of the above questions, consult your physician before engaging in physical activity. Explain to your physician which questions you answered “Yes” to. After a medical evaluation, seek advice from your physician on what type of activity is suitable for your current condition.

I hereby state that I have read, understood and have answered all the questions above honestly. I confirm that I am voluntarily engaging in an acceptable level of exercise given my knowledge of my health and taking into account any medical advice I have received.

There are inherent risks in participating in a programme of strenuous exercise. If I sustain or claim to sustain an injury while participating in my personal training sessions, I acknowledge my Mobile PT Personal Trainer, the company Mobile PT, it's staff and affiliates are not responsible.

I agree to the statement above *
General
How did you hear about us? *
Your answer
Occupational
What is your occupation? *
Your answer
Does your occupation require extended periods of sitting? *
Does your occupation require extended periods of repetitive movement? *
Recreational
Do you partake in any recreational activities (golf, tennis, skiing, etc)? If yes, please explain. *
Your answer
Have you worked with a personal trainer before? *
If you answered yes to the question above, please give a brief summary of your experience.
Your answer
Please give a brief explanation of your exercise history. *
Your answer
Is there a specific piece of exercise equipment or type of exercise you particularly enjoy? If yes, please explain. *
Your answer
Medical
Do you smoke? *
Have you ever had any surgeries? If yes, please explain and include which area or side of the body was affected. *
Your answer
Has a medical doctor ever diagnosed you with a chronic disease, such as coronary artery disease, high blood pressure, high cholesterol or diabetes? If yes, please explain. *
Your answer
Are you currently taking any medication? If yes, please list. *
Your answer
Have you ever had any pain or injuries (ankle, knee, back, shoulder, etc)? If yes, please explain and include which area or side of the body was/is affected. *
Your answer
Goals
What would you like to achieve from personal training? *
Your answer
Please rank the following goals in order of importance. 1 = VERY / 5 = NOT VERY. *
1
2
3
4
5
Muscle Gain
Weight Loss
Toning
Sport-Specific
Improved Fitness
Rehabilitation (Knee, Back, Hip, Shoulder etc)
Improved Strength
Improved Endurance
Core Strength
Improve knowledge of exercise technique
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