Questionaire

Full Name

Phone/Mobile

Gender

Male

Female

Identify as neither

Age

How close do you live or work to Rohnert Park/Cotati?

5 mins or less

5-10 min

10 mins or more

What is your profession?

What is the level of activity at your job? (None, Light, Moderate, Heavy)

None

Light

Moderate

Heavy

Are you currently exercising (at least two days per week)?

Yes

Please list any physical activities you do in your spare time.

Do any of the following medically diagnosed health conditions apply?

high blood pressure (hypertension)

heart disease

diabetes

asthma

Other (please list below)

Other medically diagnosed health condition(s).

Do you currently have any chronic injuries?

Yes

If yes, please list.

Have you worked with a personal trainer before?

Yes

Have you in the past or currently experienced issues related to stress and motivation?

Yes

If yes, please explain in a few sentences.

How is your water intake (approx how many 8oz glasses per day)?

Rate your readiness for change on a scale of 1 to 10 (be honest with yourself)

How would you rate your sleep and daily energy levels?

Great

Good

Mediocre

Poor

Goals & Expectations

Click the down arrow and choose any and all that apply to you related to your primary fitness goal.

Describe any other specific goals or expectations you have and why have you chosen these particular goals (optional).

Assuming we’re a good fit, how long would you be willing and able to commit to personal training?

1-3 months

3-6 months

6 months or more

What is an ideal time for you to meet for personal training sessions? Please note current scheduling limitations may apply.

How many times per week are you interested in training sessions?

Please choose one or more session lengths you’d be willing and able to do

30 min

45 min

1 hour

If applicable, are you interested in an upfront commitment with a session package (includes 10% discount)?

8 sessions

12 sessions

16 sessions

Training Gym location for sessions and membership. Please choose one option below:

Powerfit Personal Training in Rohnert Park

Chalk it Up Strength in Cotati

Either option works for me

Any other considerations you’d like to share?

CANCELLATION POLICY

I have a “day-before” cancellation or reschedule policy. Depending on the circumstances (sudden sickness or family emergency), I can use my discretion to waive this policy or reschedule as necessary. First late cancellation is a half of the normal session price, second time or after, a full session price will apply.

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Personal Fitness Questionnaire

Goals & Expectations

707-337-7237

Kickstart The Stronger You