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?
