Personal Training Consultation Form
Please complete this form prior to your first session.
Your Personal Details
Full Name:
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Date of Birth:
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Full Address:
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Email:
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Mobile:
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Your Health Goals
What health goals would you like to achieve in the next 3 months?
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Name 3 things you could do in order to improve your health:
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What are your main reasons for starting a fitness programme?
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How would you describe your general health and fitness?
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What exercise have you done in the past?
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What type of exercise do you enjoy the most?
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What type of exercise do you dislike the most?
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What would you say are the main barriers preventing you from exercising?
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Diet & Nutrition
On a scale of 1-10 (with 1 being poor and 10 being excellent) how would you assess the quality of your eating habits?
Would you like any help or advice in changing the quality of your eating habits?
How much Alcohol do you consume on a weekly basis?
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Do you Smoke?
Medical History
Have you had a major illness or injury in the last 5 years? If yes please give details
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Are you receiving treatment for any diagnosed medical condition? If yes please give details
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Are you taking any prescription medication? If Yes please give details
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Please indicate if you have ever experienced any of the following symptoms. Do you:
Are you pregnant or have you given birth in the last 6 months?
Structural Health
Please give details or any aches, pains or problem areas:
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Disclaimer
I have read, understood and accurately completed this questionnaire. I confirm that I am voluntarily engaging in an acceptable level of exercise, and my participation involves a risk of injury.
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