First and Last Name: Email: Phone Number: Personal Trainer: Availability (list all days and times you're available to train): Tell us about your goals? (Fitness, Health, Wellness, Life) What is driving you to make a decision? Why are your goals important to you? Why now? What do you see as your biggest obstacle in achieving your goals? What is your commitment level? 1-10 (1 = no commitment, 10 = incredibly committed) —Please choose an option—12345678910
Rate your stress level 1-5 (low-high) ---12345
Rate your diet 1-5 (good-bad) ---12345
Rate your sleep 1-5 (good-bad) ---12345
Rate your activity level 1-5 (high-low) ---12345
Rate your overall well-being 1-5 (good-bad) ---12345
Total:
How are you motivated? (Drill Instructor, Friendly but firm, Friendly & patient) What’s your favorite type of workout? What about your least favorite? List any serious injuries, surgeries, medications, issues: Is there anything else we should know?
