Personal Training Questionnaire Main Reason For Wanting A Free Initial Fitness Assessment *(Required)Main Reason For Wanting A Free Initial Fitness Assessment * I'm new to Personal Training and not sure what to expect. I was let down by another Personal Trainer in the past and would like see if we are a good fit for each other before I commit. I'm not yet sure if Personal Training can even help me. It's just easier to get started this way. Select AllDo you have Pain or Discomfort? *(Required)Please select oneNoLower BackMid/Upper BackNeckShoulderElbowHipKneeAnkle/FootMultiple Body PartsNot SureNot Listed AboveWhat Does the Pain or Discomfort Stop Or Limit You From Doing? *(Required)Do you smoke or use a vaporizer alternative?(Required)Do you smoke or use a vaporizer alternative? Yes No Do you drink alcohol?(Required)Do you drink alcohol? Yes No How many hours do you regularly sleep at night?(Required) Describe your job:(Required)Describe your job: Sedentary Active Physically Demanding On a scale of 1-10, how would you rate your stress level (1=very low, 10=very high)?(Required) Is anyone in your family overweight?(Required)Is anyone in your family overweight? Mother Father Sibling Grandparent Select AllWere you overweight as a child?(Required)Were you overweight as a child? Yes No What is you occupation?(Required) Does your occupation require extended periods of sitting?(Required)Does your occupation require extended periods of sitting? Yes No Does your occupation require repetitive movements?(Required)Does your occupation require repetitive movements? Yes No Does your occupation require you to wear shoes with a heel (e.g., dress shoes, work boots)?(Required)Does your occupation require you to wear shoes with a heel (e.g., dress shoes, work boots)? Yes No Do you partake in any recreational physical activities (golf, skiing, etc.)?(Required)Do you partake in any recreational physical activities (golf, skiing, etc.)? Yes No When were you in the best shape of your life?(Required) Have you been exercising consistently for the past 3 months?(Required)Have you been exercising consistently for the past 3 months? Yes No What if anything stopped you in the past?(Required)On a scale of 1-10, how would you rate your present fitness level (1=Worst, 10=Best)?(Required) Please list in order of priority, the fitness goals you would like to achieve in the next 3-12 months? (Please note time frame)(Required)Why specifically did you chose today to take action towards achieving your goals?(Required) Once achieved, how will life be different for you?(Required) On a scale of 1 to 10, how committed are you to making changes starting today?(Required) What you feel are the obstacles or your potential actions, behaviors or activities that could impede your progress towards accomplishing your goals (i.e. not training consistently, upcoming vacation, busy season at work, not following the program, allowing other responsibilities to become a priority over exercise etc.).(Required)So that we can schedule your Free Fitness Assessment as soon as possible, please provide us with:Name(Required) First Last Phone(Required)Email(Required) How did you hear about us? Consent(Required) I agree to the privacy policy.
