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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?
*
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?
*
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.
*
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?
*
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?
*
Have you ever trained with barbells before?
Yes
No
How committed are you to reaching your goals?
*
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?
*
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?
*
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?
*
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?
*
Do you understand that major changes can take months/years to achieve?
Yes
No
How would you rate your dietary habits?
*
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?
*
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?
*
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?
*
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?
*
Do you have gym access?
Yes
No
What kind of equipment does your gym have?
*
What kind of equipment does your gym have?
Are you interested in online training?
*
Are you interested in online training?
Yes
No
Maybe
Are you okay working out with one other person?
*
Are you okay working out with one other person?
Yes
No
Maybe
Why do you want this? What will succeeding mean for you?
*
Submit
