P.S.A. Pre-Exercise Questionnaire
(912) 337.6062
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Name *
Address *
Email Address *
Mobile Number *
Occupation *
Gender *
Height
Weight
Date of Birth
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T-Shirt Size
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Which results do you wish to achieve? *
Required
Where do you want to achieve your results? *
Required
When would you like to achieve these results? *
Why do you want to achieve these results? *
How many days per week do you wish to exercise? *
How long have you been thinking about exercising with a personal trainer? *
What has kept you from starting sooner? *
On a scale of 1 - 10 (with 10 being most important), how important is it for you to achieve your results? *
Least Important
Most Important
Do you smoke? *
Do you drink? *
Are you pregnant? *
Have you ever had or currently have any of the following? *
Required
Untitled Title
I understand that my Personal Trainer (PT) is not able to provide me with medical advice with regard to any medical conditions I may have and that this information is used only as a guideline to the limitations of my ability to exercise.  I will not hold my PT liable in any way for any injuries that may occur while I am training.
Date Form Completed
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