Remote Training Client Intake Questionnaire
First Name
Last Name
Best email address to receive programming:
Best phone number to contact you:
Date of Birth
Emergency Contact Name and Number
Your goals or aims are what you intend to achieve. Research shows a positive link between people with clearly thought-out goals and their level of success. What do you hope to achieve through remote training? (Check all that apply)
Weight loss
Weight gain
Build muscle
General fitness
Aerobic conditioning
Build strength
Improve flexibility & mobility
Improve overall mental wellness
What are your top 3 fitness goals?
Do you have a specific event or date by which you'd like to achieve the above goals? If so, what is the event and/or date?
What will motivate you in achieving the above goals?
On a scale of 1-10, how motivated are you to achieve these goals, with 1 being "not even a little motivated" and 10 being "so motivated I could BURST"?
Select an option
1
2
3
4
5
6
7
8
9
10
What, if any, are barriers/obstacles/hinderances to your success in achieving your goals?
How would you describe your current knowledge of exercise and fitness training? (Check all that apply)
I am not familiar
I have a little experience
I am very familiar
I am an expert
Have you ever had a personal trainer or strength coach before?
yes
no
What is your history with exercise and/or fitness?
What fitness activities have you participated in over the past 6 months? (hiking, strength training, cycling, swimming, etc - al count)
How would you rate your current fitness regime?
N/A - don't have one
Not effective at all
Seeing some results
Absolutely crushing it!
What equipment, if any, do you have access to? (Check all that apply)
Kettlebells
Barbells
Bumper plates (or steel plates)
Resistance bands/therabands
Dumbbells
TRX
Squat rack
Jump box
Flat or incline bench
I do not have access to anything at this time
Other (please list below)
Other fitness equipment:
How many workouts per week would you prefer?
2
3
4
5
Submit
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