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Fitness and Exercise
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Personal Training
Personal Training
Application
Name
First
Last
Date of Birth
MM slash DD slash YYYY
Gender
Male
Female
Nonbinary
Prefer not to say
Address
Email
Mobile Phone
Home Phone
Work Phone
Preferred Method of Contact
Email
Phone Call
Text
What goals would you like to achieve? Check all that apply.
Improve overall health and fitness
Increase strength
Boost energy and stamina
Improve flexibility, range of motion
Prepare for a race, event, or trip
Improve balance and stability
Support weight management
Use equipment with confidence
Support recovery after injury or illness
Learn proper form and safe exercise habits
Enhance sports performance
Other
Other goal not mentioned above:
Health considerations:
Recent surgery (past 12 months)
Past surgery or injury
Physical limitations or restrictions
Current medications
Other health/medical
Details regarding health considerations:
(Required)
When are you able to meet with a personal trainer?
Select day(s):
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
What time(s) on Mondays?
What time(s) on Tuesdays?
What time(s) on Wednesdays?
What time(s) on Thursdays?
What time(s) on Fridays?
What time(s) on Saturdays?
What time(s) on Sundays?
