Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Do you have any exhisting medical conditions? *

Yes

No

Do you have any past injuries, surgeries, or chronic pain issues? *

Yes

No

Are you currently taking any medications or supplements? *

Yes

No

Do you have any allergies or dietary restrictions? *

Yes

No

On average, how many hours of sleep do you get per night? *

Less than 5

5

5-6

7-8

9+

How would you rate your stress levels? (1 = Low, 5 = Very High *

1

2

3

4

5

How active is your job/lifestyle? *

Mostly sitting

Some movement

Physically demanding

How many meals do you typically eat per day? *

1-2

3-4

5+

How rarely do you eat out or order takeout? *

Rarely

1-2 Times per week

3+ times per week

How much water do you drink daily? *

Less than 1L

1-2L

2+L

Do you currently track your daily calories? *

Yes

No

Have you worked with a personal trainer before *

Yes

No

How often do you currently exercise? *

Never

1-2 times per week

3-4 times per week

5+ times per week

What types of exercise do you currently do? (if any) *

Strength Training

Cardio (running, cycling, swimming)

Martial Arts/Sports

Group Fitness Classes

Other:

What are your top 3 Fitness Goals? *

Fat Loss

Muscle Gain

Strength Improvement

Endurance & Conditioning

Mobility and Flexibility

Sports Performance

Other:

What is your biggest motivation for training? *

Improve overall health

Look better/improve composition

Increase energy & daily function

Compete in a sport or event

Mental health & stress relief

Other:

On a scale from 1-10 how committed are you to making changes in your fitness and lifestyle? *

1-2

3-4

5-6

7-8

9-10