Name
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First Name
Last Name
Email
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Phone
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(###)
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Emergency Contact Name & Phone
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Age
Current Weight (lbs)
Height
Do you know your current body fat percentage? (If yes, please enter it. If not, leave blank.)
Do you know your BMI? (Optional)
Are you currently taking any medications that might affect exercise?
How would you describe your daily activity level?
Sedentary (mostly sitting)
Lightly Active (light daily movement)
Moderately Active (exercise 3-5 times/week)
Very Active (hard exercise daily/physical job)
Athlete/ Extremely Active
What’s your occupation? (This helps me understand your daily activity level.)
What are your top 1–3 fitness goals? (e.g., build glutes, lose weight, get stronger, feel more confident)
Have you ever worked with a personal trainer before? If yes, what was your experience like?
How would you describe your current fitness level?
Beginner
Intermediate
Advanced
How many days per week are you currently working out?
What types of exercise have you done in the past 6 months?
Do you have any current or past injuries I should know about? If yes, please explain.
Do you have any diagnosed medical conditions? If yes, please describe.
Do you currently experience any of the following?
What does a typical day of eating look like for you? (You can write a short summary or upload a 3–5 day food log.)
Do you follow any specific diet? (Keto, vegan, intermittent fasting, etc.)
Do you track calories or macros currently?
Yes, regularly
Sometimes
No, never
Do you have any food allergies or intolerances? (Please list.)
Any religious or cultural dietary restrictions I should know about?
Are there any foods you dislike or won’t eat?
How many hours of sleep do you typically get per night?
On a scale of 1–10, how would you rate your current stress level?
What time of day do you prefer to train?
How motivated are you to reach your fitness goals? (1 = not at all, 10 = extremely)
What’s the #1 thing you struggle with when it comes to fitness?
What helps you stay motivated and on track?
What would success look like to you in 3 months?
Waiver Agreement
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Date
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