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    Client Info Form

    Uploaded by

    kamalsalman
    This document is a personal training client information form for The Birdcoop fitness center. It collects confidential information about a client such as their name, contact details, health history, lifestyle habits, goals and areas for improvement. The form is to be completed and returned prior to a client's first personal training session so that their trainer can develop the best customized exercise program to help the client achieve their fitness and health objectives.

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    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd

    Client Info Form

    Uploaded by

    kamalsalman
    251 views2 pages
    This document is a personal training client information form for The Birdcoop fitness center. It collects confidential information about a client such as their name, contact details, health history, lifestyle habits, goals and areas for improvement. The form is to be completed and returned prior to a client's first personal training session so that their trainer can develop the best customized exercise program to help the client achieve their fitness and health objectives.

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    This document is a personal training client information form for The Birdcoop fitness center. It collects confidential information about a client such as their name, contact details, health history, lifestyle habits, goals and areas for improvement. The form is to be completed and returned prior to a client's first personal training session so that their trainer can develop the best customized exercise program to help the client achieve their fitness and health objectives.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    251 views2 pages

    Client Info Form

    Uploaded by

    kamalsalman
    This document is a personal training client information form for The Birdcoop fitness center. It collects confidential information about a client such as their name, contact details, health history, lifestyle habits, goals and areas for improvement. The form is to be completed and returned prior to a client's first personal training session so that their trainer can develop the best customized exercise program to help the client achieve their fitness and health objectives.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    PERSONAL TRAINING CLIENT INFORMATION FORM

    Congratulations for choosing a Personal Trainer at The Birdcoop! To help you not only reach but also excel
    with your fitness and lifestyle goals. The information you provide below aids your Personal Trainer to
    develop the best-suited program for your needs. All information provided below is confidential.

    ****PLEASE COMPLETE AND RETURN THIS FORM


    TO THE BIRDCOOP PRIOR TO YOUR 1ST SESSION.****

    Name: _______________________________ Trainer: ___________________

    Date of Birth: ________________ Age: ______ Male or Female

    Address: ____________________________________________________________

    City: _________________________ Postal code: ________________

    Home #: _______________ Work #: ______________ Other #: ________________

    Occupation: _________________________ Sedentary or Active

    HEALTH QUESTIONAIRE
    When was your last medical check up? ____________________

    Do you smoke? YES or NO

    Do you have any heart conditions? YES or NO

    Do you ever experience pain in your chest while exercising? YES or NO

    Is your blood pressure high? Yes or NO Medication: ___________________________

    Do you ever lose balance because of dizziness or lose consciousness? YES or NO

    Do you have any muscle, bone or joint conditions? YES or NO _________________

    Do you have any of the following conditions or any other conditions we should know about?
    Diabetes, arthritis, asthma? _______________________________________________________

    Do you suffer back pain or any other pain? YES or NO ________________________________

    Have you had any surgery in the past two years? YES or NO If yes please explain:

    _________________________________________________________________________

    Do you know any other reason why you should not do physical activity? YES or NO

    Please explain: _____________________________________________________________


    LIFESTYLE AND FITNESS
    Are you taking any medications, vitamins or supplements? YES or NO If yes please list:

    _________________________________________________________________________

    List any potential “sabotage activities” activities: IE: junk food, alcohol, desserts etc:

    _________________________________________________________________________

    How physically active are you presently? Times per week: _______ Length: _____________

    Type: ____________________________________________________________________

    If your fitness level is low please explain why? ____________________________________

    Best time to exercise? _____________ Times per week wanted: _______________

    Have you had a Personal Trainer before? YES or NO

    GOAL SETTING
    Check off the areas you would like to improve on. Please prioritize… number 1 being most important to you.
    Increase Energy: ____ Decrease health risks: ____ Sleep better: ____
    Gain lean muscle: ____ Improve eating habits: ____ Reduce stress: ____
    Reduce body fat: ____ Decrease injury pain: ____ Increase health: ____
    Tone and shape: ____ Other: ____________________________________________

    Goal: _______________________________________ Achievement date: _____________

    AREAS TO IMPROVE
    Please list the areas below that you most want to improve.
    IE: Abs, arms, lower back etc.

    1._______________________________________

    2. _______________________________________

    3.________________________________________

    MOTIVATION SCALE 1 – 10 (please circle one)


    (Not very motivated) 1 2 3 4 5 6 7 8 9 10 (Very motivated)

    INFORMED CONSENT

    I, _____________________________, on _____________________ understand the risks related


    to starting an exercise program. I have signed a Birdcoop Waiver. This is my informed consent
    to be placed on a personal exercise program with my Personal Trainer to improve my overall
    wellness.

    _________________________ ___________________________
    Witness name Participant’s signature

    _________________________ ___________________________
    Witness signature Parent or Legal Guardian signature

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