Personal Trainer Assessment Form

Personal Trainer Assessment Form Date: _________________ Name Name : ______ ________ _____ ______ _____ _____ _____ _____ ___ Address: Address: _______________ _______________________ __________ __ City City:: ____ ______ ____ ____ ____ ____ ____ ____ ____ ____ __ State: ________ Telephone: Telephone: (____) _____-________  _____-________  Email: Email: _______________ _______________________ __________  __ 

Gender: Date Date of Birt Birth: h: Emergency Emergency contact :(name, :(name, relationship, relationship, telephone) telephone) ____ ______ ____ ____ ____ ____ ____ ____ ___ _ (___ (_____ ____ ____ ____ ____ ___) _) (____) _____-_______  

1. What days are best for you to participate in the training program? 2. What time of day is it best for you to participate in the training program? measurements (height, chest, waist, hips, arms, weight): 3. Body measurements

Ht:_____ Ht:_____ Ch:_____ Ch:_____ W:_____ W:_____ H:____ A:____ Wt:____lbs. Wt:____lbs. 4. Please describe your training goals briefly.

5. How would you rate your motivation towards your training goals (low, medium, high, very high)? 6. What is the main motivating factor behind you joining a training program? 7. Are you satisfied with your weight? If not, what body weight would you like?

8. Are you motivated enough to follow a rigorous training regime for up to 2 months with a controlled diet? 9. Have you been training in the last year? If yes, please describe any improvements in your fitness level.

10. What are the main things that you are looking forward from the training program?

11. How many months are you ready to spend to achieve your objectives?