Homework Exercise Programming Form
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Name *
Email *
Date *
What are your health and fitness goals? (ex. general health, lose weight, gain lean muscle, improve bone health, performance etc...) *
List all exercise equipment you have at home. No equipment is fine. *
Are you currently a member of a box gym ex. LA Fitness, 24 Hour Fitness,etc.... *
List your desired workout schedule.  Ex. Monday - at home workout, Tuesday - Personal Training at OC Fitness, Wed - at home workout.... (this is important for me to design your Monday-Sunday exercise plan on the calendar) *
List any hobbies or physical activities you enjoy that could be added to your plan. Ex. walking, biking, swimming, hiking, yoga, pilates, boxing etc... *
If you have any injuries or exercise limitations, list them below *
Do you have a FitBit, Apple Watch or a step tracker? *
Do you have stairs in your home? *
List your preferred day(s) off from training. (if any)
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Any comments, questions or concerns
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