Consultation Form

Client Name:

Date:

1. What are your major goals / targets?

 Weight loss / gain

 Sporting goal

 General fitness

 Improved flexibility

 Hypertrophy

 Muscular endurance/strength

 Nutrition/Diet

 Other:

 Increase fitness level

2. Are there any body parts in particular that you wish to train?

 Arms

 Legs

 Stomach

 Glutes

 Other?

 Whole Body

 Chest

3. What are your top three fitness/nutrition goals?

4. How long after beginning your training do you expect it to take to begin to see changes in your body?

 6 weeks

 4 weeks

 26 months

 12 months +

 1 week

 2 weeks

5. Do you have a specific event / date you want to achieve these by?

6. Have you ever trained at a gym or had a personal trainer before?

7. If you currently exercise, what would you say your routine is:

8. What will motivate you to achieve your goals?

9. How motivated are you to achieving your goals?

1 Least

2

3

4

5 Most

10. What, if any, are your expected barriers towards your exercise program?

11. How many days do you require a personal trainer for?

  5 days

  3-4 days

  2 days

 1 day

12. What time of the day do you prefer?

 Evening

 Morning

 Afternoon

13. Would you like to keep track of your changes/measurements

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.