Personal Training Questionnaire Form

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Personal Details

Full Name: *

Date of Birth: *

Age: *

Contact Number: *

Email: *

The Coaching Process

Fitness coaching can help you to meet the goals that you have for your fitness when you take the time to develop a solid relationship with the coaching professional. It is the coach’s objective to motivate you and hold you accountable for achieving your goals. From an outside standpoint, a fitness coach may be able to see areas of concern that you are not able to discern. In that sense, the process raises your awareness of a different way to handle your fitness goals.

What is Expected of the Client

The client is expected to attend each session on time and ready to work. They may need to be open to changes in their goals as the coaching process evolves. Coaches are not judgmental but impartial. To that end, coaches will ask the tough questions and expect the tough answers in order for growth to take place both personally and professionally, but only as it pertains to the clients fitness goals. However, clients do maintain the right to decide what topics to cover and to terminate a subject if they don’t want to discuss it further.

What is Expected of the Coach

The coach is expected to listen to the client and their desires and work within that guideline as much as possible. Guidelines will be set down for each session ahead of time so that the client is aware of what behavior will and won’t be tolerated. The goal of each coaching session is to work through setbacks the client may have, clarify goals through exercises and find ways to move forward on goals with the client, i.e. creating action items. The client is expected to hold themselves accountable for what they do and don’t do to make these sessions productive.

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Body Mass Index (BMI)

Body Mass (kg): *

Height (metres): *

BMI:

Category:

Medical History

1. Are you currently taking any medications? *

Please specify: *

2. Do you have any allergies or intolerances? Please include all known allergies/intolerances regardless of whether they are food-related. *

Please specify: *

3. Have you ever had surgery? *

Please specify: *

4. Do you have any history of high cholesterol? *

Please specify: *

5. Do you have any history of diabetes? *

Please specify: *

6. Do you have any history of heart disease? *

Please specify: *

7. Do you have any history of hypo/hyperthyroidism? *

Please specify: *

8. Do you have any history of bowel disease (i.e. Crohn’s Disease, Ulcerative Colitis, Irritable Bowel Syndrome)? *

Please specify: *

9. Have you had any recent injuries? *

Please specify: *

10. Have you ever been diagnosed with an eating disorder? *

Please specify: *

11. Have you ever struggled with eating disorder behaviours (i.e. restricting food, diet pills, laxatives, binging, vomiting)? *

Please specify: *

Goals

Your goals or aims are what you intend to achieve. Research shows a positive link between people with clearly thought-out goals and their level of success.

1. What are your major goals / targets?

Weight loss / gain General fitness Aerobic conditioning Muscular endurance Muscular strength Improved flexibility Nutrition/Diet Other

If Other, please specify:

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

Legs Arms Bum Stomach Chest Other

If Other, please specify:

3. What are your top three fitness/nutrition goals? *

4. How long after beginning your training do you expect it to take to begin to see changes in your body? *

5. Do you have a specific event / date you want to achieve these by? *

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

7. If you currently exercise, would you say your routine is: *

8. What will motivate you to achieve your goals? *

9. How motivated are you to achieve your goals (5 being the highest level, 1 being the lowest)? *

10. What, if any, are your expected barriers towards your exercise programme? (e.g. long work hours, lack of facilities or time) *

Lifestyle

1. What is your occupation? *

2. How many hours on average do you work each week? *

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

4. On average, how many hours do you sleep each night? *

5. Please rate your quality of sleep on a scale of 1(Bad) to 5(Excellent): *

6. Please rate your stress levels on a scale of 1(Bad) to 5(Excellent): *

7. What does your typical day look like?

a. Time you wake up: *

b. Work times: *

c. Evening activities: *

d. Time you go to bed: *

8. How would you describe your current activity level? *

9. How would you rate your present level of fitness? *

10. Have you ever had a personal trainer/training session? *

11. Do you currently exercise? *

If you currently do NOT exercise, please go to question 20

12. How long have you been training/exercising? *

13. How often do you train? *

14. What type(s) of exercise(s) do you do? *

15. Approximately how long is each training session? *

16. Where do you exercise? *

Gym Fitness class Home Swimming pool Field/Court Track/Road Other

If Other, please specify:

17. What time of day do you normally train? *

18. Do you participate in any particular sports? *

19. Do you have access to any fitness equipment at home/elsewhere? *

20. How much time will you have to exercise each week? *

21. What did/do you like the least about exercise? *

22. What did/do you like about exercise? *

23. Do you ever skip meals? *

Which ones and how regularly? *

24. Please list out what a typical day of eating looks like for you. Please be as specific as you can and include portion sizes if possible. Do not forget to include drinks.

Breakfast

Time: *

Item(s): *

Morning Snack

Time: *

Item(s): *

Lunch

Time: *

Item(s): *

Afternoon Snack

Time: *

Item(s): *

Dinner

Time: *

Item(s): *

Evening Snack

Time: *

Item(s): *

25. Do you take any supplements or vitamins? *

Please list: *

26. Do you follow a certain diet (i.e. Vegetarian, Pescatarian, Vegan, Paleo, Keto etc.)? *

Please specify: *

27. Do you drink alcohol? *

On average, how many days a week do you consume alcohol? *

On average, how many units of alcohol do you consume in a week? *

What types of alcohol do you consume? *

28. Do you drink caffeinated beverages? *

Please list the caffeinated beverages you drink and how often you drink these: *

29. Do you smoke (tobacco products)? *

How many cigarettes per day? *

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Commitment and Attitude Agreement

I have volunteered to participate in a programme of physical exercise under the instruction of a trainer. Training may include, but is not limited to, weight and/or resistance training, cardiovascular training, and floor mat exercises.

I realise that a large portion of my success will be based on my commitment to follow instruction, changing my lifestyle, and my attitude towards the fitness programme. Unfortunately The Gym cannot guarantee results, but my willingness to work hard will improve the opportunity of success.

I have read the above policy and agree to its terms as it applies to my personal training package.

Signature: *

Tap or click on the signature above to sign

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