TODAY IS YOUR DAY OF

CHANGE

YOUR BODY • YOUR GOAL • OUR PASSION

Name: Date:

Email: Phone:

Personal Trainer: Club: Queen Street

✔ Personal Training Starter Package Fitness Starter Referral

Team Training Activity Renewal

 YO U R B O DY • YO U R G O A L • O U R PA S S I O N

Tell us more about yourself

We're excited to start this journey with you and make our time together truly impactful. To ensure we tailor
everything to your needs, it's essential to understand more about you. Your lifestyle, fitness goals, and past
experiences at the gym are all valuable insights that will help us provide personalized support. By sharing these
details, we can make sure your personal training experience aligns perfectly with your specific needs and
aspirations.

We'd love to hear about your fitness needs and goals. Understanding what you're aiming for helps us
create a personalized plan that's perfect for you. What are you looking to achieve through your fitness
journey?

Your goals are important to us, and we want to understand what drives you. Why are these goals
important to you personally? What impact will achieving them have on your life?

Achieving your goals is a big deal, and we're excited to help you get there. How do you envision your
life changing once you've achieved these goals? What benefits do you see yourself gaining?

Do you have a specific time frame related to your goal?

 3-6 Months  6-9 Months  9-12 Months  12-24 Months  N/A

On a scale of 1/10 how committed are you to achieving your fitness goals?

1 2 3 4 5 6 7 8 9 10

We all face hurdles along the way. What challenges have you run into or do you think you might face
that could slow you down? What are your plans or strategies to overcome these barriers and keep
pushing forward?

Your success is our top priority, and we're excited to be part of your journey! We’d love to know what
inspired you to start personal training and what the driving force behind your decision was. Given your
goals, how can we best support you in achieving them?

During our training sessions, we want to ensure we set you up for success from the very beginning.
How do you prefer to receive feedback and support throughout our workouts? What's the best way for
us to help you stay motivated and on track during our time together?

What aspects of fitness do you enjoy the most, and are there any you find challenging or less
enjoyable?
Exercise Related Questions

How often do you currently engage in sports or outdoor activities, and how many days per week do
you intend to dedicate to strength and cardiovascular training?
Sports/Activities: 5-6  3-4  1-2  N/A Strength/Cardiovascular Training: 5-6 3-4 1-2
Please provide a brief overview of your previous exercise history, including the
specific workouts you've engaged in, equipment you've used (e.g., free weights, machines), and any
notable achievements or progress."

List all if any of the following you currently participate in:

Group Fitness Classes  Rugby  Football  Wrestling

Rock Climbing  Ultimate Frisbee  Soccer  Figure Skating
Swimming  Boxing  Hockey  Horseback Riding
Hiking  Golf  Tennis  Dance (variations)
Cycling  Basketball  Triathlon  Canoeing
Pilates/Yoga  Baseball  Volleyball  Mountain Biking
Running  Lacrosse  Martial Arts  Skateboarding
Walking  Skiing/Snowboarding  Gymnastics  Badminton
Curling  Powerlifting  CrossFit  Biathlon

Other:

Lifestyle Related Questions

Have you ever or currently smoke cigarettes?  YES  NO If yes, how many per day?

Recreational drug use?  YES  NO If yes, how often?

Drink alcohol?  YES  NO If yes, how often?

Drink coffee?  YES  NO If yes, how many per day?

Hours of sleep at night?  4-6  6-8  8+

Rate your job activity?  Sedentary  Active  Physically Demanding

Rate your daily activity outside of work  Sedentary  Active  Physically Demanding
Training Schedule

What is your preferred time to exercise?  MORNING  AFTERNOON  EVENING

How many times per week? 1-2  2-3  3-4  5-6

Ideal weekly training schedule (please list the preferred time of day to train at the gym)

MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY SUNDAY

Nutrition Related Questions

Have you ever lost weight or attempted to lose weight utilizing any of the follow dieting methods?

 Atkins Diet  Ketogenic Diet  Vegetarian Diet  Vegan Diet  High Carb Diet  Paleo Diet  Low Carb
Diet

History of chronic dieting?  YES  NO

Do you have any food allergies or food intolerances?  YES  NO

If yes, please list below

How many meals per day do you eat (including snacks)? 1-2 2-3 3-4 5-6

Do you drink water regularly throughout the day?  YES  NO

Protein: One protein source included with each meal?  YES  NO

Vegetables: 6-10 servings per day, with one serving of dark leafy green?  YES  NO

Added sugar: Less than one serving day (Includes flavored drinks and sauces)?  YES  NO

How often do you eat fast food or eat at restaurants?  Often  Sometimes  Rarely  Never

Do you do your own grocery shopping?  YES  NO

Do you do your own cooking?  YES  NO

How often do you eat processed foods?  Often  Sometimes  Rarely  Never
Health History: Physical Activity Readiness Questionnaire (PAR Q)

• Has your doctor ever said you have a heart condition, and that you should only do physical activity recommended by a doctor?
• Do you feel pain in your chest when you do physical activity? Yes No Yes No

• In the past month, have you had chest pain when you were not doing physical activity? Yes
es No
• Do you lose your balance because of dizziness or do you ever lose consciousness? Yes No
• Do you have a bone or joint problem (back, knee, or hip) that could be made worse by a change in your physical activity? Yes No
• Is your doctor prescribing drugs (for example water pills) for you blood pressure or heart condition? Yes No
• Do you know of any other reason why you should not participate in physical activity? Yes No
• Have you had surgery in the last 2 years? Yes No
• Are you currently taking any medications (Aspirin, Tylenol, Birth Control etc.)? Yes No
• Do you experience or have a family history of the following: Stroke High Cholesterol Cancer Arthritis Asthma

High or Low Blood Pressure Fibromyalgia Depression Diabetes Osteoarthritis Heart Disease

• Pain or Stiffness in: Back Knees Neck Shoulders Hips

Signature: Witness:

If you answered 'yes' to any previous surgeries or experience joint pain or stiffness, please provide details in the space provided
below