Personal Training Consultation Form
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1
Personal Information
2
Lifestyle & Goals
3
Nutrition
4
More Information
PERSONAL INFORMATION
1. Name
*
First
Last
2. Email
*
Email
Confirm Email
3. Gender
*
Male
Female
Prefer not to say
Age
*
4. Profession
MEDICAL DISCLOSURE:
1. Has your doctor ever said you cannot exercise for medical reasons?
*
Yes
No
2. Do you have any current/recent injuries
*
Yes
No
3. Do you have any history of heart disease, high/low blood pressure, diabetes or other known conditions?
*
Yes
No
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Training
1. How often do you currently train? (Tick below)
*
Never
1-3 times a week
4-5 times a week
6+ times a week
2. How often would you like to train (This will be incorporated into your plan)
*
3. What barriers do you face with training?
4. What are your main goals with training? (Tick as many as are applicable)
*
Weight loss
Strength
Hypertrophy/weight gain
Endurance
Stability
Mental improvement
Just generally feeling fitter
Trying to break the pattern of a sedentary job and just start moving!
Improve Sport Performance
Manage Chronic Health
5. What are your main concerns with reaching your goals (if any)
*
6. (Regarding 1:1 training) how often would you like to have a PT session ?
7. What is your schedule like, have you got a preference for when you’d like to train?
*
9. Are you currently participating in weight training?
Yes
No
10. Are you currently involved in regular aerobic exercise, such as hiking, jogging, cycling, swimming, step aerobic, etc?
Yes
No
11. How many minutes - hours per day can you devote to your workout?
*
30 - 45 Minutes
45 - 60 Minutes
60 - 90 Minutes
90 minutes - 2 hours
2 hours +
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NUTRITION & PERSONAL CARE:
1. What barriers do you face with your nutrition? (Tick as applicable)
*
Frequent snacking
Low appetite
Frequent takeaways
2. How often do you snack?
*
Frequently
Occasionally
Never
3. Would you describe the following as high, moderate or low:
Please make sure to pick one
Sugar intake
*
High
Moderate
Low
Fruit intake
*
High
Moderate
Low
Salt intake
*
High
Moderate
Low
How often do you drink?
*
Frequently
Occasionally
Never
How often do you smoke?
Frequently
Occasionally
Never
How much sleep do you get?
> 10 Hours
7 - 10 Hours
6 - 9 Hours
3 - 5 Hours
< 3 Hours
4. Do you currently track your calories ?
*
Yes
No
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PERSONAL:
Please note the following questions are quite personal, but these are just to ensure accurate tracking of your progress. Please be assured that these details will not be shared with anyone else apart from yourself and the trainer without informing you.
1. What is your current weight (kg) ? Please take an accurate and recent measurement
*
2. What are your current measurements (inches) ?. This will allow for clearer tracking, but please inform me if these measurements cannot be attained:
*
Right thigh (mid)
Left thigh (mid)
Bum(fullest)
Right bicep relaxed
Right bicep flexed
Left bicep relaxed
Left bicep flexed
Hips
*
Waist
*
3. Could you provide a full body picture of the following: Front profile, side (both) profile and back profile
*
Click or drag files to this area to upload.
You can upload up to 10 files.
*If not in underwear, please ensure your choice of clothing allows for an accurate representation of your physique i.e light/thin clothing:
Thank you for taking the time to answer these questions. This allows me to get to know you a bit better, so we can really tailor the plan to suit you! I can't wait to see the results 🙂
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