Personal Information & Medical History

Emergency Contact Phone Number *

Have You Been Cleared to Exercise from Your Doctor? *

Yes

Waiting for Appointment

Do You Have Any of the Following Medical Conditions? (Check all that apply) *

Other Medical Conditions:

Are You Currently Taking Any Medications? (If yes please specifiy) *

Yes

Have you experienced any pain or discomfort during physical activity in the past? Please describe. *

Are there any specific movements or exercises that have caused you pain previously? *

Training History & Current Activity

How would you describe your current activity level? *

Sedentary (little to no exercise)

Lightly active (light exercise 1-3 days/week)

Moderately active (moderate exercise 3-5 days/week)

Very active (intense exercise 6-7 days/week)

Extremely active (intense exercise daily & physical job)

What types of exercise have you participated in regularly during the past year? *

Have you worked with a personal trainer before? *

Yes

If Yes:

For How Long?
What did you enjoy most about the experience?
What did you enjoy least about the experience?

Please List Any Sports or Recreational Activities you Engage In: *

What are your primary fitness goals? (Check all that apply) *

Why are these goals important to you? *

What specific results would make you feel your training has been successful? *

What timeline do you have in mind for achieving your goals? *

How many days per week are you able to commit to exercise? *

Psychology & Mindset

On a scale of 1-10, how would you rate your current motivation to make fitness-related changes? *

What typically motivates you most effectively? (Choose top 3) *

What obstacles or barriers have prevented you from reaching your fitness goals in the past? *

How do you typically respond to challenges or setbacks? *

What factors might potentially interfere with your training consistency? *

When you've successfully maintained fitness habits in the past, what helped you stay consistent? *

Sleep, Nutrition, & Lifestyle

How would you describe your current eating habits? (Select the option that best applies) *

I don't pay much attention to what I eat

I try to eat healthily but struggle with consistency

I follow general healthy eating principles most day

I track my food intake regularly

I follow a specific diet or nutrition plan

My eating is highly variable day-to-day

Have you followed any specific nutrition plans or diets in the past? If yes, what were your experiences? *

Are you willing to discuss and potentially modify your nutrition habits as part of your fitness program? *

Yes

Maybe

How many hours of sleep do you typically get each night? *

How would you describe your typical stress levels? *

What strategies do you currently use to manage stress? *

Health & Fitness Information Sources

Where do you typically get information about fitness and nutrition? (Check all that apply) *

Other (Please Specifiy)

Who are some fitness or nutrition personalities you follow or trust for advice? (Please list names) *

What nutrition approaches do you believe are most effective for health? (Check all that apply) *

Other (please specify)

Which of the following statements do you agree with? (Check all that apply) *

All calories are equal regardless of source

"Seed oils" (vegetable oils) are harmful to health

Raw dairy products are healthier than pasteurized

Supplements can replace a balanced diet

"Detox" programs are necessary for health

Natural ingredients are always safer than synthetic

You must avoid all processed foods to be healthy

Certain foods have "negative calories"

Spot reduction (targeting fat loss in specific areas) is possible

How important is it to you that your trainer's methods align with current scientific research and evidence-based practices? *

If research contradicted something you strongly believed about fitness or nutrition, how would you respond? *

Have you had success with any specific fitness or nutrition approaches in the past? Please describe what worked and why you think it was effective. *

Are there any foods, supplements, or training methods you consider "non-negotiable" in your approach to health? Please explain. *

Training & Learning Preferences

On a scale of 1-10, how open are you to trying new training methods that might be different from what you're familiar with? *

How do you prefer to learn new exercises? *

How much do you want to understand the "why" behind exercises, versus simply following directions? *

What has been your most positive experience with fitness or physical activity? What made it positive? *

What has been your most negative experience with fitness or physical activity? What made it negative? *

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