EmailMeForm
Name
*
First
Last
Age
Gender
*
Female
Male
Contact Information
Email
*
Home Phone
*
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Cell Phone
*
###
-
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Best way to reach you:
*
Please select
Email
Call
Text
Do you prefer a male or female trainer?
*
Please select
Female
Male
No preference
What are the best times for you to exercise with a trainer?
*
What are the best days for you to exercise with a trainer?
*
What are your personal goals for your health/fitness?
*
What are your expectations from a trainer?
*
Are you involved in a consistent exercise program? (Example: a group fitness class)
Yes
No
If yes, what type of exercise program?
What is your present athletic ability?
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Low
1
2
3
4
5
High
What is your present cardiovascular condition?
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Low
1
2
3
4
5
High
What is your present flexibility?
*
Low
1
2
3
4
5
High
What is your present muscular strength?
*
Low
1
2
3
4
5
High
How many days per week will you devote to exercise?
*
1-2 days per week
2-3 days per week
3+ days per week
What are some exercises that interest you? (Example: walking, jogging, swimming, etc.)
*
What are some areas of improvement?
*
Improving cardiovascular fitness
Improving flexibility
Increasing muscular strength
Increasing energy levels
Improving mood/ability to cope with stress
Improving performance in specific sport
Losing weight
Gaining muscle mass
Improving muscle tone/shape
Improving diet/eating habits
Generally feel better
Enjoyment of life
Other
If you selected other in the answers above, please be specific.
Any injuries the trainer needs to be aware of before starting?
*
Yes
No
If yes, what is the injury/injuries?
Any medical issues the trainer needs to be aware of before starting?
*
Yes
No
If yes, what are the medical issues?
