This information is essential to helping your trainer develop a safe and effective program that addresses your needs, goals, and interests. Below you will find all the information needed below to get started:
· Client Questionnaire: Simply paste this text and information in to a word or email document and return via email to ckrelations@yahoo.com
· Fitness testing: Fitness testing will allow us to create a program geared to suit your needs and give you a baseline to measure progress each month.
Section #1: Client Questionnaire:
Client Contact Information:
Name:__________ Date of Birth ___/___/___ Age_____
Address: ___________________________________
Street City Zip code
Home Phone:_____________ Work phone:______________ Cell phone___________
Email address:____________________
Occupation:____________________________________
Client Questionnaire: Goal setting questionnaire:
Please list in order of priority, the three fitness goals you would like to achieve in the next month_______________________________________________________________________________
Please list in order of priority, the three fitness goals you would like to achieve in the next 3-6 months__________._______________ _________________________________________________
Please list any current or prior injuries you have experienced which may affect exercise or any areas of the body in which you currently experience pain or stiffness:
__________________________________________________________________________________
Please list your daily occupation. Do you spend the majority of your day seated, standing and/or a combination of both? This will affect posture and the way we design your program.
_________________________________________________
List where you currently workout (gym, home, etc) and all exercise equipment which you currently own or have access to________________________________________________________________
Please give a bit on your background on your strength training history (how many years have you actively strength trained?) List 2-3 days of your current fitness routine (cardio + strength training) in a separate email_______ _______________________________________________________________________________________________________________________________________________________________
Please list current activities and interests (golf, tennis, etc)_______ ______________________________________________________________________
Section #2: Posture and core testing:
· Record your results in the log provided below
· Re-test every four weeks to gauge improvement
Plank Test:
- Perform one set of 30-60 seconds.
- Record whether you were able to keep your back flat for over 30 seconds
- Did you feel this exercise in your abs, low back or shoulders?
Doorway Leg Raise:
- Does your heel clear the doorway on each side?
- Does your down leg clear the doorway on both sides?
- If not, perform lower body stretches every day.
Fists Behind Back:
- Do your fists almost touch or are they separated by a large space?
- Does this change when right hand is on top versus left
- If either of the above is the case, perform upper body stretches daily and devote more stretching to tighter side.
Strength Testing:
- Record number of reps you were able to complete and the position adopted to do so (for example, performing pushups with hands on a chair versus the floor)
- Record number in last box next to exercise
Test log Date- | Month 1 | Month 2 | Month 3 | Month 4 |
Plank | ||||
Fist behind back | ||||
Doorway leg raise | ||||
Push up Split squat Pull up |
