TORQUE Online Training Questionnaire
Please fill out the form below with the most honest and accurate information. This is essential to helping your trainer develop a program that addresses your needs, goals and interests that is safe and effective. All information will be treated as strictly confidential.

Once we've reviewed your responses, we will reach to confirm if you've been approved for the program and inform you of next steps

Please reach out to katy@torquebarbell.com if you have any questions.

PERSONAL DETAILS
First Name *
Your answer
Last Name *
Your answer
Email Address *
Your answer
Phone Number *
Your answer
City, Country *
Your answer
Age *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Gender *
Height *
Your answer
Weight (LBS) *
Your answer
Goal Weight (LBS) *
Your answer
Body Fat %
Your answer
LIFESTYLE INFORMATION
Occupation *
Your answer
How would you describe your current level of daily activity? *
Your answer
How many hours of sleep do you get per night? *
Your answer
TRAINING INFORMATION
How many days per week do you currently workout? *
Your answer
How long have you been working out consistently? *
Your answer
How many days per week can you realistically get to the gym? *
Your answer
Other regular sports or physical activities: *
Your answer
Give an example of your current workout routine (ex. Mon: Chest/Arms, Tues: Legs, etc.) *
Your answer
Current 1 REP Max Squat (LBS):
Your answer
Current 1 REP Max Bench (LBS)
Your answer
Current 1 REP Max Deadlift (LBS)
Your answer
List training goals (ex. bigger arms, stronger hamstrings): *
Your answer
List any injuries: *
Your answer
NUTRITION INFORMATION
List a typical day of eating - or - your last 2-3 days of food/drink (include portion sizes): *
Your answer
List any food restrictions:
Your answer
PAR-Q/MEDICAL HISTORY
Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor? *
Do you feel pain in your chest when you do physical activity? *
In the past month, have you had pain when you were not doing physical activity? *
Do you lose balance because of dizziness or do you ever lose consciousness? *
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? *
Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition? *
Do you know if any other reason why you should not do physical activity? *
If you answered 'Yes' to any of the above 7 questions, please give more detail.
Your answer
WAIVER/RELEASE OF LIABILITY
THIS AGREEMENT AFFECTS YOUR LEGAL RIGHTS. READ CAREFULLY!
You, the Member, are aware that there are risks associated with participating in Fitness activities and exercise. Your participation is completely voluntary, and you freely accept and fully assume all responsibility for all risks, and all possibilities of personal injury, death, property damage or loss to yourself or any other person as a result of your participation in fitness activities. You and your heirs, next of kin, executors, administrators and assigns agree: A) to waive all claims, known or unknown, that you have or may have in the future against Torque Barbell Inc., Torque Powerlifting, Powerful Athlete Training Inc., including their owners, officers, directors, agents, employees, volunteers, business operators, independent contractors and site property owners or lessees (the “organization”); B) to release and forever discharge Torque Barbell Inc., as well as Powerful Athlete Training Inc. from all liability for any personal injury, death, property damage or loss resulting from your participation in fitness activities due to any cause, including but not limited to negligence (failure to use such care as a reasonably prudent and careful person would use under similar circumstances), breach of any duty imposed by law, breach of contract or mistake in error of judgment of Torque Barbell Inc., Powerful Athlete Training Inc.; and to be liable for and to hold harmless and indemnify Torque Barbell Inc., Powerful Athlete Training Inc. from all actions, proceedings, claims, damages, costs demands, including court costs on a solicitor and own client basis, and liabilities of whatsoever nature or kind arising out of or in any way connected with your participation in fitness activities. C) that you permit the use of your photo or video for promotional purposes.Please consult your physician prior to starting an exercise or fitness program, and prior to using the Facility. *
TORQUE INFORMATION
How did you hear about us? *
Your answer
What was the reason you decided to start a TORQUE Program? *
Your answer
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