Personal Training Questionnaire

Please fill out this questionnaire. I’ll be in touch shortly so we can get started!

Name (required)

Email (required)

Phone

Address

Age

Height

Weight

Body fat percentage (if known)

Health History

Medical history, surgeries, or diagnoses

Medications and supplements

Allergies

Regular menses? If no, explain

Children? How many? How old?

Any significant weight changes in the past year? If yes, please explain.

Were these weight changes intentional or unintentional?

Sleep habits? Average amount of hours? Quality?

Food and Eating Habits

Detail any food allergies

List all food preferences (in a perfect world, what would you eat daily?)

List any food obstacles

How many times a day do you eat? Include snacking and drinks and time of day.

Where do you tend to eat your meals and snacks?

What does a typical day of eating look like? List out specific foods.

Exercise/Activity/Training

Are you exercising or active? If so, where do you train, what is the setting like, and what are you doing? Be specific.

How many times a week? How often? For how long?

Rate the activity level of your job with sitting being a “1” and walking/lifting/moving being a “5”.

Training history

Training goals - state short term and long term goals

Sleep

Typical bedtime and wake time during the week and on weekends.

Detail your pre-bed activities.

Do you take naps?

Evaluate quality of sleep.

Evaluate general waking energy levels.

Stress Management

On a scale of complete bliss to HOLY SH*T!!!, how stressful would you rate your everyday life?

List current perceived stressors

Active Recovery

Detail active recovery techniques (stretching, massage, yoga, etc.).

List other fitness activities you perform.

Injury Rehabilitation

List all relevant injuries, past and present.

Detail all exercises or movements that you cannot perform to full function.

Fun and Play

What do you do for fun?

If time and money were no object, what would you like to do for fun?

Do you have enough fun and play in your life?

Personal Growth

Are you currently participating in any personal growth projects?

Are there any projects that you wish you had the time/energy/motivation to begin?

Temperance

Do you use tobacco products, drink alcohol, smoke weed, etc?

Cop to your bad habits, and tell me why you may be a bit of a handful to work with!

Goals

What are your current goals regarding: (in 30 days...in 3 months...in 6 months...in one year)

Food/diet:

Athletic/performance:

Body:

What do you think will make it difficult for you to reach these goals?

Why do you feel like you need MY help?

Any other comments?