| Your Name* |
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| Email* |
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| Member Number* |
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| Phone* |
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| Age* |
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| Gender*
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Current Exercise Regimen
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On a regular basis, how many days a week do you devote to cardiovascular exercise, strength training, and/or flexibility? Please expand below. |
| Cardiovascular
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| Strength
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| Flexibility
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| Which of the following cardiovascular exercises/machines have you used? (please check all that apply)
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| Which of the following resistance training methods have you used? (please check all that apply) |
Free Weights |
Weight/Selectorized Machines |
Bodyweight Exercises |
| Have you participated in a structured exercise program in the past? (please select one) |
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| If you answered YES, how long have you participated? |
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| Do you have any physical limitations that might prevent you from doing resistance or cardiovascular training? (Please list any exercises or machines that aggravate existing conditions or those you prefer to avoid in your program)
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| How many days per week and how much time per session do you have to devote to resistance training? (Please check appropriate days per week and time per session)
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| How many days per week and how much time per session do you have to devote to cardiovascular training? (Please check appropriate days per week and time per session)
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| Are there any specific areas you would like to target in your workout? |
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| If you like to work with a specific personal trainer for your 8-week program please put their name here |
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| Additional Comments:
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