Personal training Full Name * First Name Last Name Date of Birth * MM DD YYYY Age * Phone * (###) ### #### Email * Emergency Contact Name * First Name Last Name Emergency Contact Phone * (###) ### #### Health History * Please check all that apply. Heart condition or chest pain High or low blood pressure Diabetes or thyroid condition Asthma or breathing issues Dizziness or fainting Joint or back problems Arthritis or osteoporosis Surgery or hospitalization (last 12 months) Pregnancy (current or recent) None of the above Medications (if any): Do you smoke? * Yes No Do you drink alcohol? * Yes No Doctor's clearance to exercise? * Yes No Not sure Current workout frequency: * None 1-2x/week 3-4x/week 5+/week Have you worked with a trainer before? * Yes No Preferred training styles: * Weights HIIT Cardio Functional Mobility Yoga/Pilates Other Preferred time to train: * Morning Afternoon Evening Flexible Past or current physical activities/sports: Primary goals (check up to 2): * Fat loss Muscle gain Strength Endurance Flexibility General Fitness Sports Performance Event prep Short-term goals (3 months): * Long-term goals (6+ months): * What are your biggest challenges (time, motivation, injuries, etc.)? * Liability Waiver * I confirm that the above information is accurate. I understand that I should consult a physician before starting an exercise program and that I am participating at my own risk. I release the trainer and facility from any liability for injury resulting from participation. Yes Thank you! STAY CONNECTED ON SOCIAL.
