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Personal Training Inquiry Form

 

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Photo contributed by Corinne Kazarosian, CQK Design Inc.

Name

Phone number and e-mail

Where did you hear or read about Fitness By Day?

Do you prefer to exercise at a gym or at your home?

Which cities/towns do you live and work in?

What time of day do you prefer to exercise?

 

Goals and Current Health and Exercise Status
   

Do you have any health problems that may impact your ability to exercise? If so, please describe.
   

 

Are there any areas of your body you are particularly stiff or sore? If so, where and to what degree?
   

What are your top three fitness goals?
Yes No  
Have you exercised in the past?
Are you exercising currently?
    What does your current program consist of?

 
    How effective has this program been for you?

What are the top 3 lifestyle, motivational, time constraints, and other challenges do you expect to encounter?
Yes No  
Have you had a personal trainer in the past?
    If so, what was the experience like for you?
   

What expectations do you have of personal training?

Diet

Have you ever been on a diet in the past? If "yes" please explain.

Are you currently on any specific diet? If yes, please explain.
Do you usually eat breakfast?
What types of foods do you enjoy most?

How many meals do you eat per day?
How many times per day do you eat snacks and what snacks do you normally eat?

What do you perceive as your top 3 dietary challenges?