Client Health Questionnaire

Your Name
Date Of Birth
Date
Address
Phone Number
Email
Emergency Contact
Current Weight
Height
Have you ever had a personal trainer? When? Where?
What did you like about working with them?
What did you dislike about working with them?
What do you want to accomplish with your fitness program?
What type of motivation do you expect from your trainer?
Do you own any exercise equipment? what type?
What are your current leisure activities?
How much time are you willing to devote to an exercise program, hours/week?
Have you ever had heart trouble or coronary disease?	Yes No
Do you have a family history of heart problems or coronary disease?	Yes No
Do you have a history of high blood pressure? (140/90)	Yes No
Are you overweight	Yes No
Has your doctor said you have high cholesterol?	Yes No
How much water do you drink per day?
Have you ever participated in a diet or nutrition program?	Yes No
What would you like to change about your health or the way you look?
How did you hear about Top Guns Fitness?
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