FitnessQuest Personal Training & Consulting
New Client Profile


Date of Birth

Occupation

Height

Weight


How did you hear about us
?
Date

Name

Address



Phone

Cell Phone

Email Address
Personal Goals
Primary Training and Nutrition Objectives (check one or more)
Strength

Shape & Tone

Reduce Stress
Weight Loss

Injury Rehabilitation

Cardiovascular Endurance
Fat Loss

Build Muscle

Sport Specific
List areas of the body you specifically want to work on

Is there a specific time frame in mind

Training experience

Anything else you would like to discuss about your goal
s
Do you currently
have any injuries?
If yes, please explain:
Please list any health problems you have
or have had that have been diagnosed or
treated by a health professional:



Please list any medications you
may be currently taking:
How many hours of sleep do you get per day? (average)

Have you ever suffered from insomnia?

How many meals do you eat daily?

Do you eat meat?

Do you snack?

Do you have any dietary restrictions or allergies?

Do you smoke?

Do you ingest alcohol?

Are you currently taking  a multivitamin, mineral or any
other type of food supplement?

How much water would you say you drink per day?

What do you eat for breakfast?

Do you have support at home, with friends and/or
family with changes in you lifestyle?

List any foods you do not like or refuse to eat:
Yes
No
Yes
No
Favorite food:

Favorite snack:

If yes, what type:

If yes, how much?

If yes, how much?

If yes, what?
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
How many days a week would you like to train?

When would you like to start?

What times and days are best for you to workout?




How flexible is your selected schedule above?

Do you prefer a male or female trainer or doesn't
matter?

Where would you like to train? In home or gym?

When is the best time to contact you?

Do you text message?

Do you check email often?

What form of communication do you prefer?
Yes
No
Yes
No
Phone
Text
Email
Any form of communication is fine
                                                                             Waiver  

By agreeing to this document, I acknowledge that I have voluntarily chosen to participate in a program of
progressive physical exercise which can enhance the musculoskeletal and cardiorespiratory systems. I am
aware of my responsibility to consult with my personal physician regarding my medical fitness to engage in
strenuous exercise and a nutritional support program.

By agreeing to this document, I acknowledge being informed of the possible strenuous nature of the
program and the potential for unusual, but possible, physiological results including, but not limited to,
abnormal blood pressure, fainting, heart attack or death.

By agreeing to this document, I assume all risk for my health and well being and hold harmless of any
responsibility, the instructor (trainer), web site, facility or any persons administering this instrument for
any and all injuries suffered while following the training and/or nutrition program provided to me.
I Agree