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S26 Personal Training Services Form Intake
Form fields marked with an asterisk (
*
) are required.
Personal Training Consultation Questionaire
Client Information
First and Last Name
Are you a student, staff, or faculty member?
required
Student
Staff
Faculty
What is your GRCC ID number?
What is your phone number?
What is your email address?
Emergency Contact Information
What is their name and phone number?
Fitness Goals
What are your primary goals?
required
Lose Weight
Build Muscle
Increase Strength
Improve Athletic Performance
Improver General Health
Learn How to Use the Gym
Improve Mobility
Build Confidence in the Gym
Other
How confident do you currently feel in the gym? (1 not confident to 5 very confident)
required
1
2
3
4
5
What do you feel is your biggest obstacle?
required
Time
Motivation
Consistency
Knowledge
Confidence
Injury
Other
Exercise History
Have you exercised consistently before?
required
Never
Occasionally
Regularly
Very Experienced
What forms of exercise have you done?
required
Weight training
Running
Cardio Equipment
Sports
Group Fitness Classes
Stretching
Other
Are you currently exercising in a routine?
required
Yes
No
If yes, approx. how many days per week?
Do you have any current injuries, pains, or limitations?
Do you have any current medications that may affect exercise or good for your trainer to be aware of?
Thank you for completing this form. A personal trainer on staff will be reaching out to you within the next 48 hours to review your form and setup a fitness consultation meeting.
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