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Name*

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Weight*

What motivated you to try out online personal training with me?*

Do you have any medical concerns?*

Do you currently take any medications? If so, list them below. Type “N/A” if this does not apply to you.*

Do you currently take any supplements? If so, list them below. Type “N/A” if this does not apply to you.*

What is your background in fitness? (previous sports history, how long you’ve been working out and at what level, any breaks you’ve had, etc.)*

What are your current goals, and what are you hoping to achieve (weight loss/gain, strength gain, overall health, athletic performance, etc.)?*

What are you currently doing to achieve the goals listed above? Be detailed. (If nothing type N/A)*

Have you attempted to reach these goals before? If you have, why do you think you didn’t reach/sustain them? (if this doesn’t apply to you, type N/A)*

Additional Comments (Optional)

How would you describe your current level of fitness?*

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How many days a week do you exercise NOW?*

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How many days a week can you dedicate towards exercise in the FUTURE?*

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What time of day do you prefer to workout?*

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What workout equipment do you currently have access to? List ANY and ALL.*

Are there any particular exercises have caused trouble in the past?*

Are you ready to take the first step in achieving your fitness goals and schedule a consultation?*

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