Personal Training Consultation Form
Please complete this form prior to your first session.
Your Personal Details
Full Name: *
Your answer
Date of Birth: *
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Full Address: *
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Email: *
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Mobile: *
Your answer
Your Health Goals
What health goals would you like to achieve in the next 3 months? *
Your answer
Name 3 things you could do in order to improve your health: *
Your answer
What are your main reasons for starting a fitness programme? *
Required
How would you describe your general health and fitness? *
Your answer
What exercise have you done in the past? *
Your answer
What type of exercise do you enjoy the most? *
Your answer
What type of exercise do you dislike the most? *
Your answer
What would you say are the main barriers preventing you from exercising? *
Required
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? *
Your answer
Do you Smoke? *
Medical History
Have you had a major illness or injury in the last 5 years? If yes please give details *
Your answer
Are you receiving treatment for any diagnosed medical condition? If yes please give details *
Your answer
Are you taking any prescription medication? If Yes please give details *
Your answer
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:
Your answer
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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