Download - Killitfitness Client Questionnaire
©© Are you ready to kill it?…
Client Profile
Please assist me by filling out this brief questionnaire
Your Full Name:
Phone Number:
Email:
Home Address:
Gender:
Age:
Occupation and Workplace Location:
How did you first discover Killit Fitness?
Client Profile
What are you currently doing for exercise? (Please include frequency)
Have you trained with a personal trainer before, or on a coached sports team? (If yes, please explain)
Do you have a gym membership somewhere? (If yes, how much do you pay for a monthly membership)?
Do you prefer to train outdoors, in your home, a fitness facility, a combination of the above, or other?
How many days per week do you wish to train?
What do you hope I can help you achieve?
What dollar value per month do you place on your health and physical appearance? (Personal training, gym membership, nutritional plan and lifestyle guidance) :
($50-$100)($100-$150)($250-$350)($400-$600)
Client Profile
Please list your fitness goals in the categories that apply to your needs:
•Weight/Size :
•Physical Fitness Abilities :
•Internal Health & Bodily Functions :
•Nutritional :
•Events/Challenges/Sports-Related :
Do you have any Injuries or health issues that could affect your ability to exercise or maintain a diet?
Are you currently on any medications?
Do you smoke cigarettes or have quit smoking in the past 6 months?
Do you wish to train with a friend or alone? (Sessions can be administered with up to 3 people, and discounts will apply)!
Your Weekly Schedule
Time of Day
Mon Tues Wed Thurs Fri Sat Sun
Example 7am-8am
* * * * * *
Example 9am-5pm
Work(mon-fri)
Example6:30pm-10pm
* * * * * *
Please indicate with a star (*) the days and times you can potentially set aside for some form of exercise, whether it be training with a personal trainer, or doing something on your own. Please fill in the times in the left hand column as well. You may also write in any other daily commitments (such as work/school), to give me a better idea of how we can plan a healthier lifestyle for you).
Killer Packages
Killer Kick-Starter
-Consultation-Goal Setting
-Movement Screening-Exercise Program Design
-First Session (includes how-to, demos, explanations, form
correction, tips and tricks)-healthy lifestyle support
Lean & Mean
-Consultation-Goal Setting
-Monthly Measurements-Before & After Photos-Movement Screening
-Exercise Program Design-2 to 3 Personal Training
Sessions per week*(includes assisted workouts, stretches,
post-workout massage and roller)-Healthy lifestyle support
*3 sessions = added $40 charge per week
Killer Bod
- Consultation- Goal setting
- Monthly Measurements- Before & After Photos- Movement Screening
- Exercise Program Design- 2 to 3 Personal Training Sessions per week*(includes
assisted workouts, stretches, post-workout massage and roller)
- Nutritional Analysis- Dietary Needs Consultation
- Eating Plan by a Registered Dietician*- Healthy Lifestyle Support
*3 sessions = added $40 charge per week*1-Month Eating Plan
$150 flat rate
$320 / month
$600 / month
Measurements + Weigh-ins
Waist Abdomen Hips
Weight Body Fat %
Caliper Test
Bicep
Tricep
Side (rib)
Scapula
Stomach (navel)
Thigh
Calf
Pre-Training
*Example*
Weekly Goals
WEEK : / / to / /
WEEKLY GOALS : ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
STATEMENT OF COMMITMENT: ___________________________________________________________________________________________________________________________________________________________________________________________________
SpecificMeasurableAchievableRealisticTime-Bound
*Example*
BMR CalCuLator
SpecificMeasurableAchievableRealisticTime-Bound
Food + Beverage Tracker
Time of Day Mon Tues Wed Thurs
Total Calories
*Example*
Food + Beverage Tracker
Time of Day Fri Sat Sun
Total Calories
*Example*
Equipment
Weights Stabilizer Cardio Stretch Measures
Body Weight (TRX)
Stability ball Skipping Rope
Yoga Mat Scale
Barbell, Dumbbell
Bench Rebounder Stretch Band Tape Measure
Kettle bell Sturdy Chair Step-Up Roller Heart Rate Monitor
Medicine Ball Bosu Ball Elliptical Assisted Stretch
Weekly Improvement*Example*
Before + After Photos
Pre-training
*Example*