Client Questionnaire
1) Health Concerns (Allergies and or Illnesses):
2) Accessibility to a Gym or Gym Equipment (If yes, please state where or describe what
equipment you have available):
3) Hobbies:
4) Frequency of Activity Monday – Sunday (Specify exactly what the activity is,
the length of the activity and the level of intensity 1-10, 10 being vigorous):
5) Amount of sleep Monday - Sunday: Please list exact hours daily:
6) Typical Day-to-Day description:
7) Short Term Goals (Specific, Measurable, Attainable, Relevant, Time-based; ex.
Lose 5lbs):
8) Long Term Goals (ex. Lose 30lbs):
9) Food Likes and Dislikes:
10) By hiring me as your coach, what is your main goal (ex. Lose weight etc.)?
11) evening weight before bed:
morning weight after waking up:
height:
age:
goal with me (lose weight, gained weight etc):
12) Any Final questions for me?