Name Date D.O.B. Address Phone Number Email Address Current Weight How Long at Weight Height Describe your current fitness routine Describe what you would like to accomplish through your fitness program with me Aside from technical knowledge and personal attention, what type of motivation do you require and expect from a trainer? What can we do together to make your exercise program more enjoyable? What type of exercise interests you? (Check all that apply) Walking (treadmill/outdoors)Running (treadmill / outdoors)HikingSwimmingTennisCyclingStationary BikeStrength TrainingYogaStretchingPilatesDance Exercise Describe what/where you workout and what you have available to you for equipment? Rate the importance of these goals on a scale of 1 to 10 1 being not at all important and 10 being extremely important Improve cardiovascular fitness 12345678910 Body-fat weight loss 12345678910 Reshape or tone my body 12345678910 Build more muscle 12345678910 Improve flexibility 12345678910 Increase Strength 12345678910 Increase energy level 12345678910 Improve performance for a specific sport 12345678910 Improve mood and ability to cope with stress 12345678910 Feel better/improved health 12345678910 Enjoyment 12345678910 Anything else I should know about you?