Personal Analysis

(702) 845-4100
Las Vegas, Nevada, USA

First Name
Last Name *
Street
City
State
Postal Code
Mobile Phone
Please select the ways that we may contact you:	Call Text Email All
Email *
Email Opt-in
Profession(s)
Employer
Age
Gender
Height
Weight
Body Fat % (if known)
Birthday	(yyyy-mm-dd)
Emergency Contact Name
Emergency Contact Number
Could other members of your family improve their fitness?	Yes No
Are your family & friends supportive of your fitness goals?	Yes No
Do you have a gender preference for your Certified Las Vegas Personal Trainers instructor?	Male Female Either
What LVAC location(s) are most convenient for you?
For appointments, are you usually:
What days & start times are you available to begin warming up for your fitness program? List all options.
What is your most important fitness goal at this time?
What do you foresee getting in your way?
Addictions:
Are you training for a specific event or goal date (birthday, reunion, vacation, competition, etc.)?
How many days each week do you exercise?
For how long have you been consistently physically active?
List any sports, dance, or other fitness/recreational activities that you have participated in:
Do you stretch regularly?	Yes No
If yes, how often?
What are the top 3 athletic/exercise activities that you enjoy the most?
What motivated you to start the Las Vegas Personal Trainers exercise program?
What do you enjoy the most about engaging in physical activity?
What could cause a decrease in your motivation to continue with an exercise program?
Realistically, how much time would you like to spend at each session? In minutes.
How many days per week would you prefer to work?
Does your employer offer access to a company gym for employees or guests?	Yes No
List any personal trainers you have had in the past:
What is your work schedule?
Can you tolerate hard exercise?	Yes No
How do you rate the activity level in your job?
No. of Children:
Marital Status:
What is your goal weight?
Goal Body Fat %:
Goal
Which of the following statements best describes you?
How many diets have you tried in the past?
Please list
Did any work? What was the best for you?
Do you usually regain the weight you have lost?	Yes No
How long have you kept the weight off?
Do other members of your family have a weight problem?	Yes No
When did you start to gain or lose weight?
Have you always had a weight control problem?	Yes No
Do you feel “over-full” or uncomfortable after meals?	Yes No
Do you monitor your cholesterol level?	Yes No
Do you feel hungry after meals?	Yes No
Useful Information
Have you ever smoked?	Yes No
If so, how much per day?
How many years have you smoked?
When did you quit?
Please volunteer any relevant fitness information you would like Las Vegas Personal Trainers to know. This is not for insurance purposes, and all written and verbal information provided is confidential.
Check any of the following medications that you currently use, especially ones that affect heart rate or that may need a doctor’s adjustment when you lose weight or improve your health.
Referral Reward Program
Please check beside the option that best describes how you would prefer to exercise.
Diet & Nutrition Goals

Personal Analysis

Personal Analysis

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