Congratulations on taking the next step toward your health and fitness goals! I know you have many choices, and I'm so grateful you have chosen me as your personal trainer. Before I create your individualized workout program, I need to understand your history and goals.

Once you submit this form, expect to receive your workout program in 1–3 days.

Let's do this!

Name *
Date *
Has your doctor ever said that you have a heart condition and that you should only perform physical activity recommended by a doctor? *
Do you feel pain in your chest when you perform physical activity? *
In the past month, have you had chest pain when you were not performing any physical activity? *
Do you lose your balance because of dizziness, or do you ever lose consciousness? *
Do you have a bone or joint problem that could be made worse by a change in your physical activity? *
Is your doctor currently prescribing any medication for your blood pressure or for a heart condition? *
Do you know of any other reason why you should not engage in physical activity? *
If you have answered yes to one or more of the above questions, consult your physician before engaging in physical activity. Tell you physician which questions you answered yes to. After medical evaluation, seek advice from your physician on what type of activity is suitable for your current condition.
Does your occupation require extended periods of sitting? *
If yes, please explain.
Does your occupation require you to wear shoes with a heel? *
If yes, please explain.
Golf, skiing, etc.
If yes, please explain.
If yes, please explain.
If yes, please explain.
If yes, please explain.
What are your health and fitness goals? *
Check any that apply.
A support system could include your partner, friends, and family. An unsupportive social circle can make it harder to commit to a workout plan.
Weights, group fitness classes, SoulCycle, running, BBG, etc.
Running, SoulCycle, etc.
Where will you workout? *
Workout plans include 3–4 resistance workouts and 1–2 cardio workouts ranging from 30 minutes to one hour for a total of 4–6 workouts per week, based on your schedule.
In the past, what obstacles have kept you from seeing the results you want?
Check any that apply.