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GJP PT Consultation
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* Indicates required question
Name
*
Your answer
Age
Your answer
Gender
Male
Female
Non-binary
Transgender
Prefer not to say
Other:
Clear selection
Contact Number
Your answer
Occupation & Typical Working Hours (and
Remote vs. Office)
Your answer
Do you currently have any of the following health conditions:
*
Heart condition
Chest pain
Breathing difficulties
Dizziness or faint spells
Muscle or joint pain
High blood pressure
High cholesterol
Other:
Required
Have you ever been told by a doctor to only carry out exercise approved first by your GP?
Yes
No
Clear selection
Are you pregnant?
Yes
No
Unsure
Clear selection
Do you have / have you had any post-partum conditions it could help for the trainer to know about? (Incontinence, prolonged diastasis recti, etc.). If so, please share what you can.
Your answer
Are you currently taking any medication? If Yes, please list. If No, leave blank.
Your answer
Have you had a major illness or surgery in the last 5 years?
Your answer
Do you have any current injuries? If Yes, please detail.
Your answer
Do you have any historical injuries? Please detail the injury, month and year of occurrence, and outline how the recovery has been until now.
Your answer
What are your main reasons for beginning this personal training journey?
*
General health
Build muscle
Build strength
Aerobic fitness
Weight loss
Fat loss
Stress management / Mental health / Wellbeing
Overall physical conditioning
Improved flexibility
Improved confidence / self-esteem
Aesthetics / appearance
Other:
Required
Do you currently carry out any structured exercise? If yes, please tick.
No
Strength/weight training in a gym
Cardio exercise in a gym (e.g. cross-trainer, rowing, watt-bike, etc.)
Running/Jogging outside
'Body pump'/barbell/weights classes
Yoga / Pilates
Other 'conditioning' (e.g. core/abs class, barre, etc.)
Aerobics/Zumba/Dance/Aqua classes
Cycling outdoors
Swimming
Team Sports (e.g. Football, Rugby, Hockey, Netball)
HIIT/Boxing/Combat classes
Athletics (e.g. high/long jump, sprinting, hurdles, etc.)
Tennis/Badminton/Racket sports
Hiking/Power walking
Clear selection
How often do you carry out these activities (collectively)?
7+ times a week
5-6 times a week
3-4 times a week
1-2 times a week
Less frequently
Clear selection
How would you describe your current fitness level?
*
Poor - I do not exercise
Below Average - I exercise but rarely/infrequently
Average - I exercise but usually at low intensity
Above Average - I exercise 2-3 x p/w, sometimes at a high intensity
Good - I exercise 4-5 x p/w, usually at high intensity
Excellent - I exercise 6+ times p/w, usually at high intensity
Other:
How often do you currently carry out resistance training specifically in a typical week?
1
2
3
4+
Clear selection
What other physical activities do you do?
Walking
Gardening
Being active with young children (e.g. playing in the garden/park, etc.)
Manual/Physical job (e.g. plumber, builder, PT, mechanic, etc.)
Household activities (e.g. cooking, cleaning, etc.)
None
Clear selection
What would you say are your main barriers to exercise? (tick all that apply)
*
Lack of access to facilities/equipment
Lack of time
No motivation/fatigue
Injury/illness
Family commitments
Work commitments
It is not a priority/not important to me
Low self-esteem/low body confidence
Lack of knowledge
Feel unfit
Lacking consistency
Other:
Required
Do you smoke?
Yes
No
Clear selection
If 'Yes', how many per day?
Your answer
Do you drink alcohol?
Yes
No
Clear selection
If 'Yes', roughly how many units per week?
1 pint lager/cider = 3 units, 1 small glass wine/sparkling = 1.5 units, 1 single shot of 40% spirits = 1 unit
Your answer
Do you currently follow any specific diet or eating pattern? (tick all that apply)
No
Vegetarian
Vegan
Pescatarian
Low-fat
Low-carb/Atkins/Keto/Dukan
Paleo
Slimming World/WW
Intermittent fasting/Time-restricted eating (e.g. 5:2, 16/8, etc.)
Calorie-controlled
South Beach/Low GI
Slimfast
Clear selection
How would you describe your current approach/attitude towards diet and nutrition?
Your answer
On average, how much sleep do you get per night?
9+
7-8 hours
5-6 hours
less than 5 hours
Clear selection
Do you have any issues with your sleep or have irregular sleep patterns?
Your answer
Are there any other aspects of your health / fitness / preparation to begin your training programme you would like to make me aware of?
Your answer
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