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* Date Format: MM slash DD slash YYYY Do you have a preferred trainer you would like to work with?*YesNoIF YES please provide their name.What type of program schedule are you looking for?Work with my trainer every weekWork with my trainer once in a while & have a program created to follow on my own in betweenIf 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 TrainingAthletic TherapyWhen would you like to begin your training?*PERSONAL PHYSICAL HEALTH HISTORYList 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 surgeriesPlease list any surgeriesReasonYearHospital 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?