PRIVATE TRAINING Qs

please fill out the below questions to b. ready for private training

* Indicates required field

FULL NAME *

First

Last

GENDER *

MALE FEMALE

DATE OF BIRTH MONTH *

AGE *

WEIGHT IN LBS *

HEIGHT IN FT. AND INCHES *

DATE OF BIRTH DAY *

DATE OF BIRTH YEAR *

WHAT DO YOU DO FOR A LIVING? *

WHAT IS YOUR ACTIVITY LEVEL AT YOUR JOB? *

NONE [SEATED ONLY] MODERATE [ACTIVITY SUCH AS WALKING] HIGH [HEAVY LABOR]

PHYSICAL ACTIVITY OUTSIDE OF THE GYM [please list all activities at all levels that you participate in outside of the gym and the work listed above] *

HEALTH DIAGNOSIS [please list all health conditions you have been diagnosed with] *

MEDICATIONS [please list any and all medications you currently take on a regular basis] *

TREATMENTS [please list all therapies and treatments you are undergoing to treat the conditions listed above] *

INJURIES [please list any injuries you have] *

ARE YOU CURRENTLY IN THERAPY TO TREAT THE ABOVE INJURY? *

YES NO

IF YES, PLEASE DESCRIBE THE THERAPY [or reply "NONE" if you do not currently go through therapy for an injury] *

ARE YOU EXPERIENCING ANY STRESSES OR MOTIVATIONAL PROBLEMS? *

YES NO

HAS ANYONE IN 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

ARE YOU A CURRENT CIGARETTE SMOKER? *

YES NO

WHAT FOLLOWING GOALS BEST MATCH YOUR GOALS? *

WHAT IS YOUR ULTIMATE GOAL WITH YOUR TRAINING? *

WHAT TIME OF DAY WOULD YOU PREFER TO TRAIN? *

MORNING AFTERNOON EVENING

ARE YOU CURRENTLY EXERCISING 3X PER WEEK? *

YES NO

HAVE YOU TRAINED WITH A PERSONAL TRAINER BEFORE? *

YES NO

WHAT ARE YOUR EXPECTATIONS OF ME AS A TRAINER? *

EMAIL *

TELEPHONE *

I HAVE ANSWERED THE ABOVE TO THE BEST OF MY ABILITY AND KNOWLEDGE *

YES

SELECT

private training questions

please fill out the below questions to b. ready for private training

B. ON THE LIST