Client Questionnaire Name * First Name Last Name Email * Phone Number * Gender Male Female Height * Weight * Date of Birth * MM DD YYYY Which of these goals are most important to you? (You can select more than 1) * Fat loss Improved health Improved muscle mass Weight gain Improved strength Improved endurance Please list your specific goals (e.g. amount of weight loss): * If you have any, what are your specific time frames for achieving your goals? Please tick which type of progress is the most important for you: * Immediate progress that is less easily maintained Maintainable progress that may not be as fast What is your fitness / strength training experience? * Beginner Intermediate Experienced Do you currently train? If so, explain what you do and how many times per week? If you have any diagnosed health conditions, please list your condition(s): If you are currently on any medication(s), please list them. This includes the contraceptive pill: What additional therapies or interventions are being undertaken for the given health problem(s)? Please list any current or previous injuries: Do you smoke? If yes, how many per day? * Do you drink? If yes, how many units do you drink per week? (175ml glass of wine is 2 units, 1 pint of lager is 3 units) * Do you have children? * Yes No What do you do for a living? * What level of activity is required for your job? * None Moderate High What's your availability for training sessions? * Are you menopausal? If yes, what age did your menopause start? On average how many hours sleep do you get per night? * What do you think will be your biggest barrier to you achieving your goal? * Can you invest a minimum of £220 per month in order to reach your health and fitness goal? * Yes No Thank you!
