Help me, better design your program, by answering a few questions, prior to our meeting.
Name:
Phone:
E-mail:
1. Are you currently execising? yes no
If Yes, what is your current routine? Weights Cardio Only Yoga or Pilates Both weights and cardio
2. What are you immediate goals? Cardiovasular Body Sculpting Stress Reduction Both Overall General Health Other
3. Do you have any condition or injuries?
4. Do you smoke? yes no If yes, how many packs per day? If no, when did you have your last cigarette?
5. Have you worked with a personal trainer before? yes no
If yes, why did you stop?
6.What is your motivation to get to see a personal trainer? Self Spouse Family Doctor All
7. At what point in time did you feel you were your healthiest?
8. How long have you been thinking about getting healthy?
9. Would you like assistance with your nutrition? yes no
10. Does your significant other/partner exercise? yes no
11. How much time are you willing to devote to an exercise program? minues per day days per week
12. How soon could you begin an exercise program?
13. What is your motivation to get to see a personal trainer? Self Spouse Family Doctor All
Additional questions or comments?
