Personal Trainer Application Form

* PLEASE APPLY ONLY IF YOU ARE 18 YEARS OF AGE OR OLDER! *

Please answer the questions below to give me a better idea of how I can assist and challenge you along your journey!

Personal Info
Name*
First Last
Email*
Enter Email Confirm Email
Age*
Date*
MM slash DD slash YYYY
Height*
Current Weight*
(in your birthday suit)
Current Body Fat %
(if known)
I'm Interested in:*
(check all that apply)
- Online Training
- In-Person Services
- Other

Your Expectations
What are you looking to achieve during our time working together?
(Be very specific. Use S.M.A.R.T. Goals)
How soon would you like to get started?
What triggered you to achieve your goals now?
(For example, a specific event, images, family matters etc.)
How determined are you currently to achieving your health and fitness goals?

Current Activity
What gym/exercise equipment do you have access to?
What is your current workout regimen?
How often are you doing cardio?
(Do you prefer one cardio over another?)
Are you familiar with the app, My Fitness Pal?
- Yes
- No
Are you currently dealing with past or recent injuries/limitations?
Are there any current things occuring in your life that you believe will hold you back / is holding you back from achieving your goals?
Do you own a fitness tracker?
(For example, an Apple Watch, Fit Bit, etc.)
How many steps do you average daily?
(If unsure, what is your occupation? For example, sedentary, physical laborer, etc.)

Food Related
If you currently track your food, how many calories are you averaging?
Do you have any dietary restrictions or allergies?
(If yes, please explain)
Do you take any medications or supplements that could impede or expedite the journey?
How is your relationship with the body weight scale?
Are You Ready to Get Started?
Are you willing to do before/after photos?
(These are only for the purposes of analysis unless you give permission to share)
How ready are you to become the best version of yourself and why?
Social Media Accounts / Handles
(for Shoutouts)

Personal Info