Bars & Stripes Fitness Personalized Training Questionnaire
This form simply serves as a way for me to gauge your interest in the program and for future use when creating your program, should you choose to use our service. Information will not be disclosed to any third parties.
Full Name *
Your answer
Age *
Your answer
Gender *
Your answer
Weight Goal *
Current Exercise Frequency
Desired Exercise Frequency
Approach to Weight Gain/Loss
Height *
(inches)
Your answer
Weight *
(pounds)
Your answer
Current Body Fat %
(if known)
Your answer
Briefly describe your goals in your own words:
Your answer
Describe what you currently do to train:
Your answer
Please list and medical complications or health issues which might complicate, alter or prohibit training:
Your answer
Please list the exercises you are most familiar with and your level of comfort in performing them if you had to start tomorrow:
Your answer
Access to Exercise Equipment
Please select all equipment your gym has:
Do you have any dietary restrictions? If so please list them:
(vegan, vegetarian, religious)
Your answer
What are your strengths?
Your answer
Is there anything else you'd like to add or like for me to know?
Your answer
Please add your e-mail here: *
Your answer
LIABILITY RELEASE - PLEASE READ AND INITIAL WITH YOUR NAME BELOW
By entering your initials, you release, indemnify, and hold harmless, the Service Provider (Bars and Stripes Fitness) from any and all manner of actions, causes of action, suits, proceeding, debts, dues, contracts, judgments, damages, claims and demands whatsoever in law or equity stemming from the agreement between the below mentioned parties. The Client expressly agrees that this release, waiver, and indemnity clause is intended to be as broad and inclusive, and if any portion thereof is held invalid, it is agreed the balance shall, notwithstanding, continue in full legal force and effect. The Client has carefully read the foregoing release and indemnification clause and understands the contents thereof. The Client acknowledges and is made fully aware that Bars and Stripes Fitness is neither a medical doctor, licensed nutritionist, or registered dietician and that the Service Provider is only providing recommendations to The Client in question. The Client acknowledges before beginning, implementing, or using any and all of recommendations provided, that client should consult a medical doctor.
Your answer
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