Personal Training Intake Form

Name

Date of birth

Home phone

Cell phone

Gender

Male

Female

What are your objectives?

Accountability

Motivation

Education

Athletic performance

Injury prevention

Specific medical concerns

Other…

What type of trainer do you prefer?

Challenging, pushing personal limits

Gentle, guiding, nurturing

Take control

Teacher, educator, facilitator

"Drill Sargeant"

Other…

What are your top three goals?

Are you currently engaging in regular exercise?

Yes

If yes, please list your current activities

Do you currently or have you ever been diagnosed, suffered from or experienced any of the following?

Heart Attack

Stroke

Diabetes

High cholesterol

High blood pressure

Please list any medications you currently take

Please list any additional limitations you may have

What do you consider a good weight for yourself?

Current weight

Trainer preference - Name (if known)

Date you can begin training

What days/times would be best for you to meet with your trainer?

Questions about how AL!VE can help you reach your goals? Get in touch.