Name:

First Name

Last Name

Phone:

(###)

###

####

What are your major goals / targets?

select all that apply

Fat loss

Muscle gain

General fitness

Aerobic conditioning

Muscular endurance

Muscular strength

Improved flexibility

Improved posture

Sleep

Nutrition/Diet

Injury recovery

Are there any body parts in particular that you wish to train?

Legs

Arms

Glutes

Stomach

Back

Chest

Do you have a specific event / date you want to achieve these by? e.g. Wedding / beach holiday

If yes, what date?

MM

DD

YYYY

How would you describe your current knowledge of exercise and fitness training?

I am not familiar

I have a little experience

I am quite experienced

I am an expert

If you currently exercise, how would your routine is and how would you best describe your routine?

Ineffective

Effective

Very Effective

Consistent

Inconsistent

Regular

Irregular

Sporadic

How do you spend the majority of your time at work?

Standing

Sitting

Driving

Active

When you wake up you are:

Tired and find it difficult to pull yourself out of bed

Refreshed and ready to start the day

Would you characterise your life as:

Highly stressful

Moderately stressful

Low in stress

How would you consider your current body weight?

Underweight

Ideal

Slightly overweight

Very overweight

How would you describe your current activity level?

Sedentary

Moderately active

Active

Highly active

How would you rate your present level of fitness?

Unfit

Moderately fit

Trained

Highly trained

Have you ever had a personal training session?

Yes

No

How long have you been training/exercising?

A few weeks

A few months

Around a year

Over a year

How often do you train?`

Once a week

2 x week

3 x week

4 x week

5 x week

6 x week

Every day

How long is each training session?

1/2 hour

1 hour

1.5 hours

2 hours

Longer

Where do you exercise?

Gym

Home

Outdoor

Facility

What time of day do you normally train?

Morning

Afternoon

Evening

How much time will you have to exercise each week?

1 hour

2 hours

3 hours

4 hours

More

How many meals do you eat each day?

1

2

3

4

5

6

Do you ever skip meals?

Yes

No

How big would you say your meals are?

Small

Medium

Large

Extra large

Do you ever get hungry between meals?

No

Sometimes

Yes

Extremely

How would you rate your current eating habits?

Poor

Average

Good

Coffee:

Yes

No

Fizzy drinks:

Yes

No

Sugar:

Yes

No

Alcohol:

Yes

No

Salt:

Yes

No

Red meat:

Yes

No

Fried foods:

Yes

No

Drugs:

Yes

No

Tobacco:

Yes

No

Dairy products:

Yes

No

Fat-free:

Yes

No

High-protein products:

Yes

No

Organic fruits and vegetables:

Yes

No

Do any of these apply to you:

I tend to reach for food if I am tired or stressed

I allow myself cheat days

I restrict my eating and then found myself binging

I am constantly thinking about food