The Factory Client Information Sheet
INSTRUCTIONS
This is your comprehensive client information sheet in which you will be asked to provide some relevant personal information. Answers to these questions are essential in order to allow an optimally designed fitness program for you. Please answer all questions in the most accurate manner possible while being as concise as possible.

DISCLAMER
Please recognize the fact that it is your responsibility to work directly with your physician before, during and after seeking fitness consultation. As such, any information provided is not to be followed with out the prior approval of your physician. If you choose to use this information without the prior consent of your physician, you are agreeing to accept full responsibility for your decision.
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Email *
Preferred phone number: *
Name: *
How do you prefer us to contact you? *
Gender:
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Age: *
Height: *
Weight (as of this morning):
Body fat percentage (if known):
If you have any diagnosed health problems, list the condition(s):
If you are on any medications, please list them:
What additional therapies or interventions are being undertaken for the given health problem(s)?:
If you have any injuries or movement restrictions, please list them:
What additional therapies or interventions are being undertaken for the given injury(s)?:
How many meals do you eat in restaurants and/or fast food places per week?:
How many alcoholic beverages do you consumer per week?
How often do you travel?
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Are you a primary caregiver for children, individuals with a disability, or an elder relative?:
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Please give a timetable with your most normal daily schedule listing the time you wake up, work and have breaks, work out and go to sleep:
How would you describe your stress level?
Stress free, no worries
Maximally stressed, near breakdown
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What do you do for a living?:
What is the activity level at your job?:
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Does your job involve shift work?:
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If you follow a more regular schedule, do you work days, afternoons or nights?
Are you currently exercising regularly? (at least 3x per week): *
How long have you been exercising without a break?:
If you are not currently exercising regularly, have you ever been on a consistent exercise plan (at least 3x per week)?:
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If you have exercised on a consistent basis previously, how long ago and how long did it last?:
How many times per week are you performing resistance training and for how long?:
How many times per week are you performing interval cardio training and for how long?:
How many times per week are you performing low-intensity cardio training and for how long?:
How many times per week are you performing sport-specific work and for how long?:
Please list the physical activities that you participate in outside the gym and outside of work:
Have you ever worked with a trainer before?
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Which of the following best describes what you want to accomplish? *
If the previous descriptions doesn't do justice, please write a brief description of what you want to accomplish
Why do you want to accomplish these goals? *
What is your expected timeline for achieving this goal?
What is your readiness for change? *
Not motivated, unsure about changing
Ready to dominate, will do whatever it takes
What are your expectations for your trainer/coach? *
Do you have a preferred trainer/coach?
Are you interested in learning about nutrition coaching as well as training?
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