Online Training Questionnaire

Full Name

First NameLast Name

Gender

Date of Birth

MonthDayYear

Age

years

Height

cm

Weight

KG

What do you do for a living?

Whats the activity level at your job?

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

How often do you travel?

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?

Do any diseases run in your family?

Are you a current cigarette smoker?

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)?

Have you trained with a personal trainer before?

If yes what kind of training did you do:

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

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.