General Information

First name

Last name

Birthday

Month

Day

Year

Gender

Male

Female

Other

Address

Phone

Email

Occupation

What's the best way for us to contact you?

Health and Fitness Information

Do you have any medical conditions or injuries? (Please specify)

Do you have any allergies? (Please specify)

Have you had any surgeries in the past 5 years? (Please specify)

Fitness Goals

What is your PRIMARY fitness goal?

Weight Loss

Muscle Gain

Cardio Improvement

General Fitness

What is your SECONDARY fitness goal?

Weight Loss

Muscle Gain

Cardio Improvement

General Fitness

What is your current fitness level?

Beginner

Intermediate

Advanced

How many days per week do you currently exercise?

0

1-2

3-4

5+

Training Preferences

Morning

Afternoon

Evening

Preferred training location:

Gym

Home

Other

Nutrition

How would you describe your current eating habits?

How many meals and snacks do you typically eat in a day?

Do you follow any specific diet or eating plan?

Do you prepare most of your meals at home or eat out?

How much water do you drink daily?

How often do you consume fruits and vegetables?

How much protein do you consume per day, and what are your main protein sources?

Do you take any supplements?

What is your biggest challenge when it comes to nutrition?

Do you track your food intake? If so, how?

PAR-Q

Has your doctor ever said you have a heart condition and that you should only do physical activity recommended by a doctor?

Yes

No

Do you feel pain in your chest when you do physical activity?

Yes

No

In the past month, have you had chest pain when you were not doing physical activity?

Yes

No

Do you lose your balance because of dizziness or do you ever lose consciousness?

Yes

No

Do you have a bone or joint problem (for example, back, knee, or hip) that could be made worse by a change in your physical activity?

Yes

No

Is your doctor currently prescribing medication for your blood pressure or heart condition?

Yes

No

Do you know of any other reason why you should not do physical activity?

Yes

No

By checking the yes box below, you are agreeing that you have read, understood, and completed this questionnaire to the best of your knowledge. Any questions you had were answered to your full satisfaction.

Yes

No

If you are unsure, please stop here and reach out to me at primeforgefitness@gmail.com

Any additional comments or information you would like to provide:

Agreement and Signature

I hereby certify that the information provided above is accurate to the best of my knowledge. I acknowledge that I will inform my trainer of any changes to my health or fitness status.

Electronic Signature (write your full name)

Today's Date