Services

Personal Training Application

This application is used for 1-on-1 Personal Training in Santa Barbara, CA. These questions will be used to better understand your medical history, athletic history, and current goals.

 


Your Name

Your Email

Birth Date

What are your goals?

Do you have any hobbies?

Are you currently working out?

Has your doctor ever said you have a heart condition, and that you should only do physical activity recommended by a doctor?
 Yes No

Do you feel pain in your chest when you do physical activity?
 Yes No

In the past month, have you had chest pain when you were not doing physical activity?
 Yes No

Do you lose your balance because of dizziness, or do you ever lose consciousness?
 Yes No

Do you have a bone or joint problem (for example, back, knee, or hip) that could be made worse by a change in your physical activity?
 Yes No

Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition?
 Yes No

Are you currently taking any medication? (If 'Yes', please list your medications.)
 Yes No

Have you had any past injuries? (If 'Yes', please describe past injuries.)
 Yes No

Do you know of any other reason why you should not do physical activity? (If 'Yes', please explain.)
 Yes No

Do you have any other comments, or is there anything else I should know about you or your health before we start a training program?

 By submitting this application I acknowledge that the above information is true.