Personal Training Forms Details

When looking for a personal trainer, it is important to find one that is a good fit for you. To help make your decision, consider using a personal trainer questionnaire form. This will help you to better evaluate the potential trainers and determine which one is right for you. The questionnaire will ask about your fitness level, goals, and preferences. It is important to be truthful when completing the form so that you can get the most accurate information possible. Be sure to ask any questions that you have about the process so that you can make an informed decision.

This figure provides information about personal trainer questionnaire. It's advised that you look at this information before you start editing the form.

QuestionAnswer
Form NamePersonal Trainer Questionnaire
Form Length3 pages
Fillable?No
Fillable fields0
Avg. time to fill out45 sec
Other namesforms needed for personal training, personal trainer questionnaire, personal training questionnaire form, personal training consultation questionnaire

Form Preview Example

Date_____/_____/_____

PERSONAL TRAINING QUESTIONNAIRE

First Name: _________________________________Last Name: __________________________________

Address 1:______________________________________________________________________________

Address 2: _____________________________________________________________________________

City, State, Zip: ________________________________________ Date of Birth: ______/_______/_______

Phone # _______________Email:______________________________________ CWID:__________________

Affiliation: Undergrad Graduate/Doctorate Faculty/Staff Alumni Other: _______________

Emergency Contact: _______________________Relationship: _________________ Phone: _______________

1.) Please describe your current and/or previous exercise experience:

2.) How many sessions per week would you like to meet with your trainer? _______

3.) Do you plan to exercise in addition to personal training sessions? If so, how many times per week? ____

4.) Are you currently taking any over-the-counter or prescription medications or drugs? If so, please list:

5.) What are your health and fitness goals? (Check all that apply)

Weight Loss Cardiovascular Exercise

Muscle Strength and Endurance Flexibility

Other __________________

 

6.) Do you prefer working with a: Male Trainer

Female Trainer No Preference

7.) Do you have a specific trainer in mind? Yes No If yes, please specify. _______________________

Check

 

Early

Mid-

Early

Mid-

Early

Late

Preferred

 

Morning

Morning

Afternoon

Afternoon

Evening

Evening

Times/Days

 

6-8am

9-11am

12-2pm

3-5pm

6-8pm

9-12am

 

 

 

 

 

 

 

 

MONDAY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TUESDAY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

WEDNESDAY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

THURSDAY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FRIDAY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SATURDAY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SUNDAY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Physical Activity Readiness Questionnaire (American College of Sports Medicine, 1998): Check the appropriate box on each question. A physician’s release will be required if you answer “yes” to any item

listed in the box below.

YES NO

1.

Has your doctor ever said that you have a heart condition and that you should

 

 

 

only do physical activity recommended by a doctor?

2.

Do you feel pain in your chest when you do physical activity?

3.

In the past month, have you had chest pain when you were not doing

 

 

 

physical activity?

4.

Do you lose your balance because of dizziness or do you ever lose

 

 

 

consciousness?

5.

Do you have a bone or joint problem that could be made worse by a change

 

 

 

in your physical activity?

6.

Is your doctor currently prescribing drugs (for example, water pills) for your

 

 

 

blood pressure or heart condition?

7.

Do you know of any other reason why you should not do physical activity?

Additional Information: Please mark all that apply.

1. Smoke or quit smoking in the last 3 months

2. Taking medication for high blood pressure

3. Hernia or other condition that may be aggravated by lifting weights

4. Diabetes

5. Recent surgery (last 12 months) Explain:

6. Pregnancy (now or within the last 3 months)

7. Pre-existing injuries or physical restrictions that may limit your ability to exercise. If so, please explain:

RELEASE AND INDEMNITY AGREEMENT:

I hereby release the Board of Regents of Oklahoma State University and all its employees from all claims on account of injury which may be sustained while attending this class, and I agree to indemnify the Board of Regents of Oklahoma State University and its employees for any claim which may hereafter be presented as a result of such injuries.

Print Name ________________________________________________________________________________

Signature _______________________________________________________Date______________________

PHYSICIAN’S STATEMENT AND CLEARANCE FORM

At the Department of Wellness, your safety is our primary concern. For this reason, we comply with the health and fitness standards of the American College of Sports Medicine.

On the Physical Activity Readiness Questionnaire (PAR-Q), you identified that you have one or more coronary and/or other medical risk factors which may impair your ability to exercise safely. For this reason, you need to have a physician complete and return this medical clearance form before you can begin exercising at the Seretean Wellness Center or the Colvin Recreation Center.

We recognize that you are eager to start your fitness program, and we sincerely regret any inconvenience that this may cause you. However, please keep in mind that we want your exercise experience to be as safe as possible.

Please ask your physician to complete the bottom portion of this form. He/she may fax the form back to us at the number listed below.

I hereby give my physician permission to release any pertinent medical information from any medical records to the staff at the Department of Wellness. All information will be kept confidential.

Patie t’s a e t pe or pri t __________________________________________DOB _______________

Patie t’s sig ature: ________________________________________________ Date: _______________

Reason for medical clearance _____________________________________________________________

Ph sicia ’s

a

e __________________________________ Pho e _____________ Fa

____________

 

 

 

 

 

 

 

 

 

 

 

 

FOR PHYSICIAN USE ONLY

 

Please check one of the following statements:

 

I co

cur with

patie

t’s participation with no restrictions

 

I co

cur with

patie

t’s participatio i a e ercise progra with the followi

g restrictio s:

 

______________________________________________________________________________

I do not co cur with

patie t’s participation in an exercise program with the

 

 

Department of Wellness.

 

 

Reason________________________________________________________________________

Ph sicia ’s

a

e t pe or pri t

___________________________________________________________

Ph

sicia ’s signature _______________________________________________ Date _______________

Please return to:

Preston Nesemeier, B.S.

Fitness Coordinator

Seretean Wellness Center

Phone: 405-744-2379

Fax: 405-744-7670

If you believe this page is infringing on your copyright, please familiarize yourself with and follow our DMCA notice and takedown process - click here to proceed .