Questionnaire for Personal Training

Choose Your Service Level (if you are looking for personal trainer online)

Thank you for your interest in online coaching or one on one Personal Training. Please fill out client questionnaire below.Otherwise leave your name and contact information on "contact" page. All information received on this form will be treated as strictly confidential.You must fill out the form completely.This information is essential to understand how we can help you.Make sure we don't see time wasters.If you have any specific need such as contest preparation,wedding short line data or some other requests,please add your comments in the bottom line of this form.

How old are you:
Are you :
Have you experienced a recent weight gain or loss?
Do you lose your balance because of dizziness?
On average how many hours do you sleep per night?
Is anyone in your family overweight?
How many times a day do you eat(including snacks)?
Have you had chest pain when you where not in activity?
Do you suffer from Hypoglycemia?
Do you have diabetes hypertension or high blood pressure?
Do you smoke?
Do you drink alcohol?
Do you eat fast foods?
Do you skip your meals?
Your current diet could be best characterized as:
Do you suffer from Thyroid Disorder?
Are you under a lot of stress?
Are you experiencing any motivational problems?
Do you eat past the point of fullness?
Have you been exercising in your life ever?
How many glasses of water do you consume daily?
Where do you rate health in your life?
Do you know how many calories you eat per day?
How tall you are:
Your current body weight:
Do you have any health problem that causes you pain?
Do you take any medications on a regular basis?
How does this medications affect your ability to exercise?*
Have you had a recent surgery?
If you have any old injuries please list them*
Does anyone of your family has heart disease before the age of 58?
Do you suffer from asthma high or low blood pressure?
Have you ever taken any food supplements?
Your goal setting. Please check that which applies:
Set up a timeline for achieving your goal
Please rate your motivational level to accomplish your goal
Have you workout with a personal trainer before?
What would an ideal training week look like to you?*
Please be specific:*
Describe your job:*
Check what apply
What is your potential behaviors against achieving results?
How committed are you to get result?
Your name:*
Your last name:
Email address:*
Your Phone ( optional )
Your current location:*
How much you ready to pay your Online Personal Trainer?
If Online Personal Option Select Your Service Plan Below
How much you ready to pay your Personal Trainer in person?
Select location close to you or offer your own location
Your Comments*
If you found us by internet which keyword/phrase was used?*
If referred by someone please print their name below*
Upload your current images (optional) Front / Side / Back View
Competitive athlete upload your image here
Mailing list signup: Check this box to signup for our site mailing list.
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