Personal Training Form

Personal Training

Fill out this form to help us set you up with the best coach and program for you as soon as possible.

Name*
First Last
Email*
Phone*
Birth Date*
MM slash DD slash YYYY
Do you have a preferred trainer you would like to work with?*
- Yes
- No
IF YES please provide their name.
What type of program schedule are you looking for?
- Work with my trainer every week
- Work with my trainer once in a while & have a program created to follow on my own in between
If weekly, how many days per week are you looking to work with your coach?
Please enter a number from 1 to 7.
Do you have a preferred day or days of the week you like to train?*
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
- Sunday
List the top 3 times of day you are available*
Our hours of operation are:
Monday - Friday: 6:00AM – 10:00PM
Saturday & Sunday: 8:00 – 8:00PM
Would you prefer our Personal Training stream or our Athletic and Exercise Therapy stream?*
- Personal Training
- Athletic Therapy
When would you like to begin your training?*
PERSONAL PHYSICAL HEALTH HISTORY
List any current or previous physical health problems or allergies you feel would impact your ability to participate in a Personal Training program.
Please list any surgeries
Please list any surgeries
Reason Year Hospital
Please List any medications that may impact your ability to participate.
Are you experiencing any pain or discomforts currently?*
- Yes
- No
If yes, please explain.
What activities do you currently participate in?*
How many days/week?*
Please enter a number from 0 to 7.
How long is each “bout/session”?*
Please check the areas from below that are applicable to your training goals.*
- Fat Loss
- Hypertrophy
- Strength
- Flexibility/Mobility
- Cardiovascular
- Speed/Power
- Agility
- Sport Specific
What are your top two training goals for this program?*
Were you referred to PISE by anyone? If yes, who.
If no, how did you hear about Personal Training at PISE?
Disclaimer: We want to find the perfect coach to best suit your needs! It may take up to 3 weeks to organize a coach for your schedule, but we promise it will be worth the wait. We appreciate your patience!
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Reason	Year	Hospital

Personal Training Form

Personal Training

PERSONAL PHYSICAL HEALTH HISTORY

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