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Address:
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Date of Birth:

Gender

Do you have any health and/or injury conditions?

How often do you work out?

Do you work out at home or at a health club?

What health club are you a member of?

Have you worked with a personal trainer before?

Describe your current exercise program:

Days a week of weight training and body sculpting:

Days a week of cardiovascular activities:

What type of cardiovascular activities do you do?

What are your immediate goals?

What are your long-term personal health & fitness goals?

What are the most convenient days and times for you to meet with your trainer?

I want to meet my trainer:

Additional questions or comments?