Personal Training client application form E-mail* Phone number* Full Name Gender Male Female Age Hight Weight Occupation Whats the activity level at your job? none(seated only) 1 Moderate (light activity such as walking) 2 High (heavy labor, very active) Do you follow a regular working schedule, do you work days, afternoon or nights? How often do you travel? Rarely A few times a year A few times a month Please list the physical activities that you participate in outside of the gym and outside of work.:* Are you Pregnant If you have any diagnosed health problems list the condition(s).* If you are on any medications, please list them.* What additional therapies are being undertaken for the given health problem(s)?* If you have any injuries, please list them.* What additional therapies are being undertaken for the given injury?* Are you experiencing any stresses or motivational problems? Yes No Has anyone of your immediate family developed heart disease before the age of 60? Yes No Do any diseases run in your family? Yes No Do you suffer from diabetes, asthma, high or low blood pressure? Yes No if yes please list:* Are you a current cigarette smoker? Yes No Your current diet could be best characterized as: low-fat low-carb high-protein Vegetarian/Vegan Please rate your readiness for change. 1 2 3 4 5 6 7 8 9 What following goals does best fit in with your goals? Improved health Improved endurance Increased strength Increased muscle mass Why?* What is your goal with your training?* How often are you willing to train a week to reach your goal?(minimum of 2 session per week!) Please rate your motivational level to do what it takes for reach your goal. 1 2 3 4 5 6 7 8 9 Are you currently excersising regulary (at least 3x per week)? Yes No Have you trained with a personal trainer before? Yes No If yes what kind of training did you do:* At what times during the day would you prefer to train? Early-Morning 1 Morning 2 Mid-Day Afternoon How often do you want to do Personal Training a week? 2 sessions 3 sessions 4 sessions 5 sessions What are your expectations on me as your Personal Trainer?* Please Read The Following Terms and Conditions. I AGREE TO THE ABOVE TERMS & CONDITIONS!* Yes No Signature* Submit