Name:
Phone Number:
Email:
Male Female
STEP 1: Goal What is the single most important goal for you to achieve with your exercise program?
What outcomes are you looking to experience as a result of your exercise program?
In what time frame do you expect to achieve your goals?
Aside from your time at the gym, how much additional time per day are you willing to engage in activity that helps you get to your goal – such as daily walks, using the stairs, or home exercise?
Are all aspects of your workouts completely up to you or is someone or something else a consideration when designing your program variables? (your obstacles)
Do you have any present or past injuries? Do they still bother you in any way?
Do you have any medical history I need to know about? Do you take any medications?
How many days a week do you plan on working out?
What equipment do you have access to?
STEP 2: Style Is it more important for you to feel continually challenged or to feel structured during your workouts?
When you need to reduce stress do you ideally enjoy activities that are exciting, adventurous and give you a chance to blow off steam, or activities that are practical and relaxing?
Do you enjoy exercise more when it involves a routine that you can adhere to or one that offers a variety?
Are there any activities you don't like or want to avoid?
Are there any activities that you enjoy or want to try?
Does your occupation require extended periods of sitting?
Yes No
Does your occupation require repetitive movements?
Yes No
Does your occupation cause you anxiety or mental stress?
Yes No
STEP 3: Level Would you say that your work is active, sedentary or physically strenuous?
What is your occupation?
What hobbies do you enjoy?
Do you regularly participate in recreational activities? Is that monthly, weekly, more or less frequent?
Are you currently exercising? If yes, what type of exercise program are you currently participating in?
What has prevented you from achieving your goals in the past?
What is your experience with working out?
STEP 4: Motivation About Goal Why is this goal most important to you?
If you don't make these changes and stay the way you are or regress in your health and fitness, how would that affect your life? What consequences could occur?
When you do successfully reach your goal, in what ways will life be different?
What benefits are most important to you?
On a scale from 1-10 how important is it for you to make those changes right now?
Why is it not a 2 or 3?
What would make it a number higher?
Do you believe you can make these changes?
On a scale from 1-10 how confident are you?
What would make your confidence one number higher?
Are you ready and willing to change at this time?
In what ways do you believe I can help you?
