Questionnaire for Personal Training

PT questionnaire

Step 1 of 9

11%

Personal details

Name

First Last

Address

Street Address City County Postcode

Phone & email

Phone

Email(Required)

Age(Required)

Gender(Required)

Male

Female

Training history

Where / doing what / how many sessions?

Have you taken part in sporting activities in the last two years?(Required)

Yes

Please tell me which activities (tick all that apply)(Required)

Group fitness classes

Team sports

Member of a gym

Resistance training

Competitive sports

Athletics / running

Other

As you've selected 'other' for activities, can you tell me what this is please?(Required)

How active are you in a typical week?(Required)

Sedentary — desk job and little to no exercise

Lightly Active — light exercise/sports 1–3 days/week

Moderately Active — moderate exercise/sports 3–5 days/week

⁠Very Active — hard exercise/sports 6–7 days/week

⁠Extremely Active — hard daily exercise/sports and physical job or training

If you know (or can estimate) what are your typical daily steps?(Required)

Are you currently a member of a gym?

Yes

As you've answered that you're a member of a gym, can you tell me which one?

Do you have any gym equipment at home?(Required)

Cardio machines

Gym mat

Resistance bands

Skipping rope

Step

Weights

None

What's your favourite type of workout? (tick all that apply)

Cardio based

Weight / resistance training

Group fitness classes

Swimming

Running

Spinning

Dance workouts

HIIT workouts

None

Nutrition

Are you looking for advice with nutrition?(Required)

Yes

Have you ever tracked your calories before?(Required)

Yes

If you've used an app to track your calories, please let me know which one

Measurements

Your waist (the smallest part, in cm)

Your hips (the widest part, including your bum, in cm)

Your thigh circumference (in cm)

Your chest circumference (around your boobs, in cm)

Your weight (kg)(Required)

Your height (cm)(Required)

This field is hidden when viewing the form

BMI

Photos

If you’d like to see your progress using photos, please take some photos in gymwear from the front, side and back. (If you don't want to, that's fine. If you want to share these with me that’s fine, if not, keep them for yourself!)

Photo upload

Drop files here or

Max. file size: 16 MB.

Main goals

What would you consider your main goals to be (tick as many as appropriate)

Weight loss / fat loss

Become more toned

Build some serious muscle

To take part in an event I want to train for

Need some accountability

Become physically fitter

Feel better about myself

Become healthier in general

Become more confident in the gym

Build better habits

Enjoy exercise again

Now tell me why you want the above in your own words

In the box, please tell me more about you and your goals. If you have specific goals you'd like to achieve, please give me an idea of timescales you're allowing for this. If you aren't sure what you're looking for, please use this section to tell me what's on your mind and we'll agree on your goals together.

Health history

Being more active is very safe for most people, however if you are over 69 years of age, or if you answer yes to any of the below questions, please check with a doctor before taking part in any sessions.

Please answer the following yes/no questions relating to your health history.(Required)

	Yes	No
Has your doctor ever said that you have a heart condition and that you should only undertake activity under doctors advice?
Do you feel pain in your chest when you do physical activity?
Have you ever suffered from chest pain, even when not working out?
Do you ever feel faint or have spells of dizziness?
Do you have any bone or join problems which could be made worse by exercise?
Are you currently taking medication which could impact your ability to exercise?
Are you diabetic?
Do you have asthma?
Are you epileptic?
Any major injuries or surgeries in the last 5 years?
Do you have high or low blood pressure?

As you answered yes to the high or low blood pressure question, can you please tell me more?

Statements

Please read through the following statements and then tick the checkboxes to let me know they've been read and understood.

Statement one(Required)

I understand that this training programme may include exercises to build the cardio respiratory system (heart and lungs) and the musculoskeletal system (muscle endurance, strength, flexibility) and may result in body composition changes (e.g. a reduction in body fat and increase in muscle). Exercises may include walking, running, weight lifting, cardio equipment, flexibility and stretching exercises.(Required)

Statement two(Required)

I agree that using training equipment and working out with a trainer is at my own risk and I assume responsibility for any injuries or damages which may occur during session if I do not follow instructions.(Required)

Statement three(Required)

I will notify my trainer should there be any significant changes to my health, or if any unusual symptoms occur during a session.(Required)

Next of kin

I legally need to collect details about your next of kin, so please supply this information.

Their name(Required)

First Last

Their phone number(Required)

Their relationship to you(Required)

And finally...

Anything else I should know?

For example: Allergies / food intolerances / doctors advice / illnesses /history, etc

How did you first come across Kaye Louise Fitness?

Advert

At a gym

At a gym class

Facebook

Google

Instagram

Referred by a friend

Website