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.

"*" indicates required fields

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

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

Reason

Year

Hospital

Please List any medications that may impact your ability to participate.

Are you experiencing any pain or discomforts currently?*

Yes

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!

We acknowledge with respect the Lekwungen
and W̱SÁNEĆ peoples on whose traditional lands
we serve.

Get in Touch

Pacific Institute for Sport Education
4371 Interurban Rd, Victoria BC
V9E 2C5, Canada

Hours: Mon-Fri 8am-4pm

ph: 1.250.220.2500
fx: 1.250.220.2501

Charity number – 85703 8327 RR0001

Hours

Monday 7:30 am – 10:00 pm

Tuesday 7:30 am – 10:00 pm

Wednesday 7:30 am – 10:00 pm

Thursday 7:30 am – 10:00 pm

Friday 7:30 am – 10:00 pm

Saturday 8:00 am – 8:00 pm

Sunday 8:00 am – 8:00 pm

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