P3 Client Questionnaire
Health & Fitness
Date of Birth
What are you looking for help with?
Workout Split- periodization
How did you find out about P3?
What is your occupation?
Please Select the one that best describes your goals:
WEIGHT LOSS= Designed to decrase body fat with a minimal loss of lean body tissue. One will experience tighter physique by decreasing fat and water rentention.
MAINTAIN WEIGHT/CHANGE BODY COMPOSITION= Designed to maintain current body weight and develop muscle density and maturity while decreasing body fat and water retention.
WEIGHT GAIN= designed to increase lean body mass (muscle) with minimal increase in body fat. Some water retention may occur after weight training in order to assist the muscles in growth.
Why have you chosen to hire a personal trainer/ nutrition coach?
What are some obstacles (behaviors, stress, activities, etc) that you foresee impeding your success? Have you developed any plans to overcome these obstacles?
What best describes your professional activity level?
SEDENTARY= Sitting more than 7-8 hours during the work day.
MODERATELY ACTIVE= Sitting 6 hours and on your feet at least 2 hours during a work day.
ACTIVE= On your feet more than 5 hours during the work day.
VERY ACTIVE= On your feet more than 6 hours and doing periodic lifting during the work day.
Have you had recent blood work done?
Do you have any allergies you are aware of?
If you are on any medications, please list them.
How do you monitor your eating habits?
Do you feel that you eat a healthy diet most of the time?
How much water do you drink per day?
Do you consume coffee?
Do you consume alcohol?
Describe a typical day in your diet from waking until bed:
How do you feel about diets? Have you tried and "fad" diets?
Do you take supplements? If yes, please list below:
Do you have any specific cravings? If yes, for what and when?
How much sleep do you typically get?
What time do you normally wake?
When do you usually consume your first meal for the day?
Do you struggle with structure?
Any prior eating disorders or a form of disordered eating? If yes, please describe.
Do you train or do cardio on an empty stomach?
Have you been exercising consistly for 3 months?
How long have you been exercising?
When were you in your best shape?
When did you decide to get in shape?
Have you begun an exercise program in the past?
Were you successful?
What if anything stopped you from continuing?
What is different this time?
Current Program/Program Development
Realistically, how often are you willing to exercise?
How long are you willing to spend at each exercise session?
List any other cardio/sports/activities that you are involved in:
Do you have any injuries or surgeries? Please list any details, even if you think they may not be important.
Are there any specific exercises that you are unable to perform? Please list:
Should be Empty:
Copyright 2018 JotForm Inc.