Name *

First

Last

Phone *

Date / Time

Date

Time

Date of birth

How many timer per week do you exercise?

How long do you normally exercise for?

How long have you been exercising?

Have you had a personal trainer in the past?

If yes, how was your experience?

Does your job/ daily routine keep you active?

Do you consider your job stressful?

Why?

Do you smoke?

If yes, how many cigarettes do you smoke per week?

How well do you sleep?

How many hours do you sleep per night on average?

What kind of exercise do you prefer?

Which of the following are important to you?

If you would like to gain weight, how much would you like to gain?

If you would like to lose weight, how much would you like to lose?

List your top 3 fitness goals in order of priority.