Online Training Questionnaire

Full Name*

First NameLast Name

Gender

MaleFemale

Date of Birth*

MonthDayYear

Age

years

Height

cm

Weight

KG

What do you do for a living?

Whats the activity level at your job?

none(seated only)Moderate (light activity such as walking)High (heavy labor, very active)

Do you follow a regular working schedule, do you work days, afternoon or nights?

How often do you travel?

RarelyA few times a yearA few times a monthWeekly

Please list the physical activities that you participate in outside of the gym and outside of work.:

If you have any diagnosed health problems/Allergies list the condition(s).

If you are on any medications, please list them(optional).

if yes please list:

If you have any injuries, please list them.

What additional therapies are being undertaken for the given injury(optional)?

Are you experiencing any stresses or motivational problems?

YesNo

Do any diseases run in your family?

YesNo

Are you a current cigarette smoker?

YesNo

Your current diet could be best characterized as:

What following goals does best fit in with your goals?

What is your goal with your training?

Why?

How often are you willing to train a week to reach your goal?

Please rate your motivational level to do what it takes for reach your goal.

Are you currently excersising regulary (at least 3x per week)?

YesNo

Have you trained with a personal trainer before?

YesNo

If yes what kind of training did you do:

At what times during the day would you prefer to train?

MorningMid-DayAfternoonEvening

What are your expectations on me as your Personal Trainer?

* ALL THE INFORMATION I HAVE GIVEN IS CORRECT

All the information on this form is correct and to the best of my knowledge. I have sought and followed any necessary medical advice. I understand that all the information given will be kept confidential.

YesNo