Personal Training with Trisha Selbach
This form is to gather information about you, your health, fitness background, food preferences, and goals.
I'll use this information to build your plan and start you on a successful, sustainable fitness and nutrition
plan. You can expect a follow up from me within a few days of submitting this form.
Sign in to Google to save your progress. Learn more
Email *
Name
Birthday
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Phone
Height
Weight
Do you experience any of the following
Please describe the most active part of your life
Have you participated in the following in the last 10 years?
Please list any current medications
Please list any current supplements
Have you worked with the following experts
Describe your energy levels throughout the day
Describe your stress levels and how you cope with stress
Describe your sleep habits
How many times were you sick in the last 12 months and what were your symptoms?
How many children have you delivered?
Is there anything else you would like to tell me?
What is the best food in your diet?
What is the worse food in your diet?
Have you ever tracked your calories?
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How frequently do you drink alcohol and generally how many servings at a time?
Where do you purchase most of your food?
Where do you see your body in 6 months if you worked with a trainer?
Where do you see your body in six months if nothing changes?
Please give a timeline of your "diet" history.
When it comes to nutrition, what would be the most helpful to you? Having a strict food plan, understanding macros, learning how to prepare foods......?
What is the number one reason you aren't at your goal right now?
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How many workouts a week would you like in the studio
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How many workouts would you like to do at home or at a gym?
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Do you prefer
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Are you comfortable using smart phone apps to communicate with me and access home/gym workouts?
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Is there anything additional you would like me to know about you?
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