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Personal Training Questionnaire
What is your name? (First and Last)
*
What is your email address?
*
What is your phone number?
How old are you?
How tall are you?
What is your weight in lbs? (Only the number, please)
What is your gender?
*
A
Female
B
Male
C
Prefer not to say
D
Other
What is your occupation?
*
How did you hear about me?
*
A
The Training Room website
B
My Website
C
Instagram
D
Referral
E
Other
What is your primary goal? Select all that apply.
*
Do you have any orthopedic issues that will limit your ability to perform exercise? If so, please list them below and elaborate on what movements exacerbate those issues.
*
Have you worked with a trainer before?
*
Yes
No
What did you like/not like about personal training?
Have you ever trained with barbells before?
*
Yes
No
How committed are you to reaching your goals?
*
0
1
2
3
4
5
6
7
8
9
10
Meh
I will stop at nothing to reach my goals
Are you willing to make this a priority?
*
Yes
No
Maybe
What do you think has been holding you back up to this point?
*
Do you get bored easily doing the same exercises?
*
Yes
No
Do you understand that this will require a lot of consistency and hard work?
*
Yes
No
Do you understand that major changes can take months/years to achieve?
*
Yes
No
How would you rate your dietary habits?
*
0
1
2
3
4
5
6
7
8
9
10
Extremely Poor
Excellent
How would you rate your stress level at this point in your life?
*
0
1
2
3
4
5
6
7
8
9
10
Little to no stress
Extremely stressed
How would you rate your sleep?
*
0
1
2
3
4
5
6
7
8
9
10
Extremely poor
Excellent
What days/times do you have available to train?
*
How frequently do you travel for more than 3 days at a time?
*
A
Once/wk
B
1-2 times/month
C
1-2 times/quarter
D
1-2 times/year
Do you have gym access?
*
Yes
No
What kind of equipment does your gym have?
*
Are you interested in online training?
*
Yes
No
Maybe
Are you okay working out with one other person?
*
Yes
No
Maybe
Why do you want this? What will succeeding mean for you?
*
Submit
