Personal Training Form

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Hi there, please fill up the form below as that would help me keep a record and have a basic insight on your requirement.

Service delivery process:

Step 1: Client Health History & Lifestyle Interview

Step 2: Blood test & other physical assessments

Step 3: Coach & client create goals and strategies. Training starts simultaneously

Step 4: Coach making any changes to the program if required by the client

Step 5: Follow up & regular interaction

Full Name *

Email ID *

Phone No. (Whatsapp) *

Age *

Gender *

Female

Male

Prefer not to say

Other:

Height *

Weight *

The goal for fitness training (Strength gain, muscle gain, fat loss, improving health markers, improving flexibility, increasing athletic performance etc.) *

What would you like to register for? *

Would you like to have a nutrition plan as well? *

Yes

Maybe

Other:

Do you participate in any of the following? Kindly check the boxes. *

Smoking

Drinking

Nothing

Other:

Required

Lifestyle *

Sedentary

Mildly Sedentary

Mildly Active

Active

Very Active

Other:

Do you suffer from any of the following? Please check the boxes. *

History of heart problems, chest pain or stroke

Elevated BP

Any chronic illness/condition

Advice from physician not to exercise

Recent surgery (last 12 months)

Pregnancy (now or within last 3 months)

History of breathing/lungs problems

Diabetes or metabolic syndrome

Muscle, joint or bone disorder or any previous injury still affecting you

Thyroid condition

Obesity (BMI) > 30 kg/m2

Elevated blood cholesterol

History of heart problems in immediate family

Hernia, or any condition that may be aggravated by physical activity

No illness

Other:

Required

Are you taking any medications, supplements or drugs? If so, please list medication, dose & reason.

Describe any physical activity you do somewhat regularly. *

Describe any recent injury (if any), if no, just type NA. *

Rate your current cardiovascular capacity (Eg, the capacity to walk, run, do aerobics) *

Rate your current flexibility *

Rate your present muscular capacity (Eg, are you able to lift all the shopping bags yourself, move heavy objects etc) *

Do you personally like working out? Rate your affinity towards it. *

Will you be able to stick to the program? Rate your commitment towards it. *

What type of exercise interests you (Eg, walking, jogging, strength training etc) *

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