Personal Training Data

Training Data:

* Indicates required field

Name *

First

Last

Email *

Date of Birth/ Age *

Height *

Weight *

Body Mass (if known) *

How many days per week can you Train? *

How many hours per session can you train? *

Are you training now? *

What other physical activities are you doing? *

Do you have a gym membership? Where? *

Describe your work/family schedule and how it will fit with training. *

What are you training goals? *

Health History Data:

Do you smoke? If so, how much? *

Has your doctor cleared you for physical activity? *

Approximate date of last exam? *

Have you had any of the following: *

heart problems diabetes high cholesterol high blood pressure

Are you overweight? *

Do you have any orthopedic problems? *

Do you have an other medical conditions? *

Describe your current exercise program. *

What are the new goals with a coach? *

Consent:

I acknowledge, to the best of my ability, that I am in good health and have no known medical problems that would restrict my ability to participate in this exercise program. (name/date) *

Submit

Training Data:​

Health History Data:

Consent:

Training Data: