Client information

Client Name

Client phone number

Client email address



What is your preferred method of contact? (Eg. Phone, email, text)

Emergency contact details

Emergency contact name and relationship

Emergency contact number

General information


Weight (kilograms)

Health Profile

Outline your current exercise regime (how many times per week, kind of activity, duration)

Are you or have recently been pregnant?

What are your short term goals (9 weeks)


What are you long term goals? 6+ months

How active is your job?

Is it difficult for you to gain weight? Can you eat a lot and still not gain weight

Do you gain or lose weight according to your fluctuations and food consumption?

Is it difficult for you to lose weight?

How aware are you of nutrition and how your body responds?


List the food, beverages, supplements etc that you take on an average day. (List as breakfast, lunch, dinner and snacks)

List any food restrictions eg. Allergies, preferences

Have you consulted a nutritionist in the past? For what reason and did it work for you?


Blood Pressure

Beats per minute

Chest (cm)

Waist (cm)

Thighs (cm)

Skin fold test (cm)

Dominant side






Upper Back

Lower Back



Body fat percentage

Weight in pounds = Body weight (kg) x 2.2

All numbers added x 27. Divide by body weight in pounds


Body fat percentage

Progress photo
Progress photo
Disclaimer and further information

Please take a moment to carefully read the following information and sign this document.
This agreement ensures that the role of the trainer to client and client to trainer is clearly appreciated and understood. This agreement must be signed prior to beginning the training sessions.

To keep this program running smoothly, we would like to outline the following client responsibilities

Be on time for sessions with your Personal Trainer. Typically each session is 30-45 minutes; however a more flexible length can be established. The time of sessions is to be agreed upon between the trainer and the client.
If the client is late, the session will only last until the end of the time that the session was scheduled.
Any tardiness of more than ten minutes or absence without proper notification will result in the loss of the session.
If a session needs to be cancelled for any reason other than an emergency, a 12 hour notice must be given to the trainer. Failure to do so will result in the client forfeiting the session and no payment reimbursement will be granted.
No roll-over sessions or refunds will be granted, except for medical reasons, which must be endorsed by your physician.
It is recommended that you bring a water bottle (NO GLASS BOTTLES) to every session. It is required that you bring a towel to every session.
Your Personal Trainer will give personal instructions based on your goals and ability and it is required that you follow these instructions on your own accord.
If by any stage you wish to cancel your Personal Training sessions, you must notify your Trainer and Manager on the Facility (Peter) via email or written letter with your reasoning.
No further contact will be made only if required.

If you have any questions feel free to contact Peter on 0402 733 783.

I agree to engaging the services of a personal trainer with Studio 99 Fitness Centre to design a program to aid in, and enhance my fitness goals. I will not hold Studio 99 liable for any problems, illness or injuries that might occur due to a change in my lifestyle. This program and training does not replace the advice of a medical practitioner, registered dietician or any medial provider or treatment. I have revealed any and all necessary information about myself to prevent any possible complications.

Client signature
Personal Trainer signature
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.