Personal Training Interest

Name
Age
Gender
Phone (XXX-XXX-XXXX)
Email Address
Personal Training Preference
 Male Trainer
 Female Trainer
 Doesn't Matter
Check ALL that apply
 I prefer to be trained in the morning
 I prefer to be trained in the afternoon
 I prefer to be trained in the evening
Health History (please list problem and medication if applicable)
Bone or joint problems
Heart Disease
High Blood Pressure
High Cholesterol
Diabetes
Other
What is your current exercise program
Strength
Cardio
Please list your 2 main goals your trainer will help you meet
Comments
A personal trainer will contact you within 24-48 hours of receiving your information.