Adrian

Personal Information

Name*

First Last

Address*

Street Address City State ZIP Code

Phone (Primary)*

Phone (Alternate)

Email*

Enter Email Confirm Email

Date of Birth*

Height*

Weight*

Emergency Contact*

Name and Number

Lifestyle

What is your current occupation?*

The specifics of an occupation can sometimes create muscular imbalances in an individual.

Does your current occupation require extended periods of sitting?*

Individuals who are seated for extended periods of time can sometimes develop tight hip flexors.

Yes
No

Does your current occupation require you to be on your feet for extended periods of time?*

Individuals who are on their feet for long periods of time can sometimes develop tight lower leg muscles.

Yes
No

Does your current occupation require you to wear shoes with heels on them?*

Individuals who wear shoes with heels on them while walking or standing a lot can sometimes develop tight lower leg muscles.

Yes
No

Does your current occupation require you to use a computer for extended periods of time?*

Individuals that work on a computer for extended periods of time can sometimes develop imbalances between their upper and middle back muscles

Yes
No

Do you experience low back pain?*

Yes
No

Please describe how often you experience it and how severe the pain is:*

Exercise History

Have you exercised in the past?*

Yes
No

Do you currently exercise?*

Yes
No

How many times a week do you exercise?*

How long do you exercise?*

Have you ever participated in a personal training program?*

Yes
No

What are your short- and long-term goals for exercise, health and fitness?*

Exercise Availability

In a week, how many days do you realistically believe you will be able to work out?*

How long (in minutes) do you believe you will be able to dedicate to a workout?*

Do you have access to a gym, health club or fitness center?*

Yes
No

If you do not have access to any of the places mentioned above, do you have exercise equipment at home? If so, what kind?*

Personal Information

Lifestyle

Exercise History

Exercise Availability

Physical Activity Readiness Questionnaire

Just For Fun

Thank you for showing interest in SoLi Fitness Online Personal Training! Let’s get you going!

Adrian

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