Fit Anywhere
Fitness Anywhere
Home
The Dream Team – Our Coaches
Our Services
Class Reservations
*** NEW – Outdoor Bootcamp
Zumba
Power and Strength Yoga
***NEW – Muay Thai Conditioning Class Reservation
Suspension Training Class Reservation
Total Body Boot Camp Reservation
Relentless Reservation
Cardio Kickboxing Reservation
Sore to the CORE Reservation
Pay Online
Client Info Forms
Body Composition Questionnaire (Nutrition Clients Only)
Client Info Questionaire (For Nutrition and Personal Training)
Group Class Participant Details Form
Contact Us
Virtual Online Personal Training – Members Only Access
Posts
Comments
Check It Out!
What’s New!
Les Infos en Francais
Fit Pregnancy
Our Group Classes
Lifestyle Nutrition
Testimonials
Disclaimer
You are here:
Home
/ Client Information Questionaire
Client Information Questionaire
Step 1 of 3
33%
Personal Information
Email
*
Name
*
First
Last
Gender
*
Male
Female
Address
*
Street Address
Address Line 2
City
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland & Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Province
Postal Code
Phone
*
Alternate Phone
Birth Date
*
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Month
1
2
3
4
5
6
7
8
9
10
11
12
Year
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Occupation
*
Physical Information
Height
Weight
% Body Fat
BMR
Calculated based on info above
Measurements (
right side only
, in inches):
Chest
Waist
Hips
Thigh
Calf
Arm (Bicep)
Medical History
Injuries, Operations, Current medications
Lifestyle Information
How would you rate your current stress levels?
(1=no stress, 10=severe stress)
Occupational stress
1-no stress
2
3
4
5
6
7
8
9
10-severe stress
Personal stress
1-no stress
2
3
4
5
6
7
8
9
10-severe stress
Work Schedule (Ex. 9 am-5pm)
Commute (ex 1 hour roundtrip)
Gym membership
Yes, member of gym
No
Distance to gym (hh:mm)
Sleep schedule (10 pm to 6 am)
Do you smoke?
Yes
No
Access to home equipment (if yes, please specify)
Current Physical Activity
Cardio activity
Cardio type
Mon
Tue
Wed
Thu
Fri
Sat
Sun
Cardio duration
Mon
Tue
Wed
Thu
Fri
Sat
Sun
Time of the day
Mon
Tue
Wed
Thu
Fri
Sat
Sun
Weights
Weights type
Mon
Tue
Wed
Thu
Fri
Sat
Sun
Weights duration
Mon
Tue
Wed
Thu
Fri
Sat
Sun
Time of the day
Mon
Tue
Wed
Thu
Fri
Sat
Sun
Your Weight/Functional Training Experience
Beginner
Intermediate
Advanced
Sports/Exercise classes
If you participate in any Sports or Exercise Classes, please describe the type and frequency per week.
Nutrition Information
Typical Daily Food Log
Breakfast
Time
Monday-Friday
Weekends
Snack
Time
Monday-Friday
Weekends
Lunch
Time
Monday-Friday
Weekends
Snack
Time
Monday-Friday
Weekends
Dinner
Time
Monday-Friday
Weekends
Snack
Time
Monday-Friday
Weekends
Supplements
Time
Monday-Friday
Weekends
Times you crave your favorite "cheat" foods and what they are?
Daily Water Intake (cups)
Daily Coffee/Tea Intake (please specify)
Alcohol Consumption/Week
Please list any Allergies (Food, Medicine, etc)
Describe your top 3 fitness goals (be specific, name your targets/dates)
Why are these goals so important for you to achieve
Upload your progress photos (.JPG, .PNG, etc...)
Please include photos of front, side and back view. Women: bikini or spandex shorts and sports bra. Men: briefs/spandex shorts
Close
