PERSONAL TRAINING REQUEST

Name *

First Name

Last Name

Phone

(###)

###

####

What day(s) of the week do you prefer for Personal Training? *

ANY DAY

Sun

Mon

Tue

Wed

Thu

Fri

Sat

What time(s) of the day do you prefer? *

Early Morning (5am-9am)

Late Morning (9am-12pm)

Early Afternoon (12pm-2pm)

Late Afternoon (2pm-5pm)

Evening (5pm-7pm)

Late Night (7pm-10pm)

What are your fitness goals and/or what do you want to learn or accomplish?

Lose Weight

Train for specific event

Injury Prevention/Rehabilitation

Learn How to Use Gym Equipment

Improve Strength

Improve Flexibility

Improve Energy

Do you have preference for your trainer?

Man

Woman

No preference

Has a medical doctor ever told you that you should not participate in physical activity or exercise? *

Yes

No