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Fitness Questionnaire

Contact Info

First name
Last name
Email

How did you first hear of or find out about Rudi's personal training?
What is your most important fitness goal?
What is your next most important goal?
Why have you not been able to achieve the above goals?

Rate how happy you are about your body. (Enter 1 if you're not happy, 10 if you're 100% happy.)

Your Looks Happy with the way my body looks, shape / size etc.
Body Feels Good Happy with muscle tone, not soft flabby, firmness,
Body Works Well Body works well, no injuries muscle / joints
Body Fat Level Happy with tummy/arms/chest/thighs/weight in pounds
Energy Levels I have high energy, great general health
Strength Levels My body is strong, no weak or injured spots
Aerobic Fitness Stamina fitness. I can jog for 20 minutes non-stop
Flexibility Is good, hardly any tight spots

IF YOU ARE NOT EXERCISING, When was the last time? What did you do?
IF YOU ARE EXERCISING. What are you doing? Times/week?
HAVE YOU EVER HIRED A PERSONAL TRAINER?

How long for?

Injuries or Health Status

Injuries or Health Status Is there any past or present injury or health condition that may affect your training? e.g. Blood pressure, etc. Any problems with:

Neck
Back
Hip
Knee
Other

Give brief details

Medication

Have you ever taken or currently taking psychiatric medication or drugs of any type?

(details please)

Personal Training

What is the main reason you are interested in Personal Training?
When do you plan to start Personal Training?
How many personal training workouts will you need to do each week?

Schedule

Please specify time ranges when you would be available to do training. Place 1^st, 2^nd & 3^rd preferences in boxes.
First Choice			to
Second Choice			to
Third Choice			to

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