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Online Personal Training – New Client Form

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First Name*
Last Name*
E-mail*
Contact Phone Number*

What equipment do you have access to?
- Full service gym like LA Fitness or 24hr Fitness.
- Limited equipment mostly dumbbells.
- Other- Please explain.
Please Explain
How much body fat do you feel you must lose?
- 0-10lbs.
- 10-25lbs.
- 25lbs. or more.
What are your fitness goals?
- I want to tone up- Think a dancer.
- I want to look athletic- Think Fitness model.
- I want to be very muscular- Think bodybuilder.
- I want to be functional and athletic- Think athlete
- I want to train for a sport and need a sports specific program.
- I have an injury that I need to train around.
What is your coordination level?
- I have never competed in sports and I have no coordination.
- I have never competed in sports but I have average coordination.
- I have competed in sports at a lower level and I am coordinated.
- I was an elite athlete and I am very coordinated

The following questions will help me better understand your needs when we speak further about your Health & Fitness goals.
How many days a week can you commit?
- 1-2
- 3-4
- 5-6
How much time each session?
- 1/2 -1 Hour
- 2 Hours
- 3 Hours
Are you physically active now?
- Yes
- No
Do you belong to a health club?
- Yes
- No
Have you ever had a personal trainer?
- Yes
- No

Are you a?
What's your age?
What's your height?
Inches
What's your weight?
What's your waist size? (inches)
Reasons for starting
How did you find us?

What are your goals?
- Flexibility
- Build
- Tone
- Strength
- Sports Improvement
- Endurance
Have you been diagnosed with a Heart Conditon
- Yes
- No
Have you or do you ever feel Faint or Dizzy
- Yes
- No
Have you ever-experienced Pain in your Chest?
- Yes
- No
Do you or have you ever had High Blood Pressure?
- Yes
- No
Do you or have you ever had High Cholesterol?
- Yes
- No
Do you suffer from Allergies or Asthma?
- Yes
- No
Have you ever had any Bone or Joint problems?
- Yes
- No
Are you taking any Medication?
- Yes
- No

Is there anything else I should know, or that you would like to add?
Name
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WHAT TYPE OF PERSONAL TRAINING ARE YOU LOOKING FOR?

Online Training

Studio Training

In-Home Training

complimentary evaluation

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Last Name*
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