full name First name last name Gender Male Female Dath of BirthYear2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Month123456789101112Day12345678910111213141516171819202122232425262728293031AgeYear HeightCMWeightKGWhat do you do for a living? Whats the activity level at your job ? none(seated only) (Moderate(light activity such as walking Hight (heavy labor, very active) If you have any diagnosed health problems list the condition(s).If you are on any medications , please list them.What additional therapies are being undertaken for the given health problem(s).If you have any injuries , please list them .Do you follow a regular working schedule , do you work days , afternoon or nights?How often do you travel? Rarely A few times a year A few times a month weekly Please list the physical activities that you participate in outside of the gym and outside of work .:What additional therapies are being undertaken for the given injury?Are you experiencing any stresses or motivational problems ? YES NO Has anyone of your immediate family developed heart disease before the age of 60? YES NO Do any disease run in your family? YES NO Do you suffer from diabetes , asthma , high or low blood pressure ? YES NO : Please list Are you a current cigarette smoker ? YES NO Your current diet could be best characterized as: low-fat low-carb high-protein vegetarian/vegan no special diet Please rate your readiness for change. 1 3 5 9 7 2 4 6 8 10 What following goals does best fit in with your goals? improved health improved endurance increased strength increased muscle mass fat loss What is your goal with your training? Why? ?tmeline for achieving your goal now 8 WKS 16 WKS 24 WKS 32 WKS 40 WKS 1YEAR How often are you willing to train a week to reach your goal? Please rate your motivational level to do what it takes for reach your goal 1 3 5 7 9 2 4 6 8 10 Are you currently excersising regulary (at least 3x per week)? YES NO Have you trained with a personal trainer before? YES NO What kind of training did you do ? At what times during the day would you prefer to train ? morning mid-day arternoon evening What are your expectations on me as your trainer? I AGREE TO THE ABOVE TERMS & CONDITIONS ! YES NO phone numberemail Nameاین فیلد برای هدف اعتبار سنجی است و باید بدون تغییر باقی بماند . Δ
