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Fitness Assessment Form

Step 1

Complete Fitness Assessment Form

Remember, not all training services are created equal. All personal trainers should accept multiple forms of payment, possess legitimate certifications, have CPR, carry liability insurance and have a background check performed.

This is the norm with Trainers On Site Mobile Personal Trainers

Personal Information

Name:
Phone Number:
Email Address:
Address:
City:
Province:
Postal Code:
Current Exercise Equipment:
(Be as specific as possible, like 10, 15, 20 lb dumbbells, 3 Different tubing)

Personal Fitness Goals

What is your health and/or fitness related goals? Please list in order or priority, please be as specific as possible.
Ex. (Lose 20 Lbs.)	Time Frame (In 4 Months)
1.	Time Frame
2.	Time Frame
3.	Time Frame

Describe why you want to achieve the goals above. (Examples: More confidence, increased energy, feel 10 years younger, able to fit in old clothes again etc.)

WORKOUT LOCATION

Home

Condo

Gym

Current Lifestyle & Fitness Status

I would rate my current physical fitness level as.

Sedentary

Somewhat Active

Active

Athletic

I would rate my current health status as.

Unhealthy

Somewhat Healthy

Healthy

Optimal Health

Physical activity is important to me.

Not important

Somewhat Important

Important

Extremely important

I enjoy exercising and living an active lifestyle.

I Don't

Somewhat Enjoy

Enjoy

Extremely Enjoy

I believe that exercise can help me succeed in achieving my health and fitness goals.

Disagree

Somewhat Disagree

Agree

Strongly Agree

Do you have any injuries or conditions that may affect your ability to perform physical activity?

Yes

If YES please list

Have you ever participated in a structured fitness program before?

Yes

IF YES, when was this and what results did you achieve?

Have you ever used a personal trainer before?

Yes

IF YES, when was this and what results did you achieve?

Are you currently enrolled in an exercise program that has at least 30 to 60 minutes of moderate activity 4 - 7 days per week?( Examples: weight training, jogging, fitness classes etc.)

Yes

IF YES, when was this and what results did you achieve?

10.

When were you in the best shape of your life? How did you feel?