Name

First Name

Last Name

Email Address

Phone

Phone Number

(###)

###

####

Height

Age

Weight

Weight in lbs

How did you hear about me?

How active are you?

Not Very Active

Somewhat Active

Very Active

How many days per week do you do cardio?

How many days per week do you lift weights?

Have you had a personal trainer before?

What have been the most difficult factors in maintaining your training in the past?

Examples: time, motivation, significant other, money

Medical History

Is there any medical history I should know about?

Injuries

Current or previous

Current Nutrition

Please describe the types of meals you eat, how many meals per day, if you cook at home or eat out, etc.

Body parts you enjoy training

Main Goals

Lose body fat, gain muscle, become more athletic

What type of program are you interested in?

MA360 FITNESS QUESTIONNAIRE