Personal Training Request Form (Jickety Jacq Fitness)
Email address *
Personal Information
First and Last Name *
Age *
Gender *
Occupation *
Phone number
Do you use Instagram? What's your username so I can follow you :D
What is your guilty pleasure TV show right now? *
Health Information
What are your Fitness Goals? Be specific. *
What are your current physical activities? *
What is your exercise history? *
Do you have any physical limitations, injuries, or health problems that restrict you from certain exercises/types of exercise? If yes, please explain. *
Have you been cleared by your doctor for exercise? *
How many days a week are you willing to devote to exercise? *
Developing your Workout Plan
What types of activities do you enjoy?
What types of activities do you want to spend more time doing/learning how to do? *
Which of the following exercise equipment do you own or have access to? *
Have you ever worked with a personal trainer before? If yes, how did that go for you? What did/didn't you like? *
Why do you want to train with me specifically? *
Are you willing to invest $50-$100/month on your health and fitness goals? *
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