Personal Training Questionnaire

* Indicates required field

Name *

First

Last

Phone Number *

Email *

Age and Birthday *

What is your ultimate DESIRE? Be specific and descriptive. If you could create anything, (not based on a story from the past- what has worked, what hasn't worked) whats present for you now *

Why do you desire this? How will life be different when you have this? What makes it uncomfortable about the way it is now? How long have you felt that way? *

90 Day Result *

6 month *

On a scale of 1-10 how important is it for you to experience these desires? *

In addition to your desired outcome, what other specific benefits would you love to enjoy? *

Please expand *

Health and Fitness status

What is your current training routine? *

How would you rate your overall health? *

Do you have any past or present injuries (even minor) that I should know about? *

Do you have any other medical conditions that must come into consideration with your training? Eg. Asthma, Fibromyalgia, Arthritis, Heart Conditions, Blood pressure, Diabetic or blood sugar sensitivity, Thyroid, Cancer etc. *

Are you on prescription medications? If so, what medical conditions are they for? *

Describe your eating style in a few words, eg 3 meal a day, Vegan, Paleo, Keto, *

As your coach I am 100% committed to your success, How can I best support you along the way? *

What interests you the most on this list? *

Other *

Do you commit to staying in touch with your coach? *

What is your Power Quote that lifts you? *

Submit