Personal Training Discovery

Name *

First

Last

Email *

Phone Number

Current Weight *

Please share your current weight in pounds (lbs)

Current Height *

Please share your current height in feet and inches (for example, 5'9").

Date of Birth *

Please share your date of birth.

Gender *

Please share your gender.

What is your biggest goal? (short & long term) *

What are some obstacles, behaviors, or activities that could slow your progress in reaching your fitness goals *

What do you expect/hope to get out of training? *

Current/ past injuries? *

Do you have any physical limitations? *

Yes
No

Please tell me more about your physical limitations *

What kind of equipment do you have access to? *

Do you workout at home, gym, outside, or other? *

Where do you workout (Other) *

Tell me more about where you prefer to workout.

How many days (in the gym) a week do you train? *

How often do you workout at the moment?

How much time do you have to train in a day? *

Let me know how much time you can dedicate to training in a typical day.

What do you need help with the most?

Training program
Nutrition guidance
Support/Accountability
Other

What do you need help with the most? (Other) *

With your current programming, what do you like or dislike? (If anything)

What is working and/or not working with your current programming? *

What are your least favorite exercises? *

What are your favorite exercises? *

train? (Other) have

Current activity level? *

Sedentary - little to no, desk job
Light - 1-3 days/week
Moderate 3-5 days/week
Very active 6-7 days/weeks

Have you ever worked with a personal trainer before? *

Yes
No

Previous Personal Trainer Experience - What did you like/dislike?) *

What has stopped you from reaching your goals in the past? *

How many hours of sleep do you get per night? *

Share the average number of hours you sleep and feel free to tell me about your sleep cycle and quality.

How stressful is your daily routine? (1-10) *

Do you take any supplements or medications? *

I take supplements
I take medication
Both
No

Tell me about the supplements you are taking *

Tell me about the medication you are taking *

Any other information you want to share *

Privacy Agreement *

I consent to having this website store my submitted information so they can respond to my inquiry.

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