Questionnaire - Fitness Down Under

For anyone wanting to have a productive workout and have fun at the same time, Fitness Down Under is for you! Adrian will work with you at your level while pushing you to improve.

More Energy
Better Muscle Tone
Lose Weight
Getting fit for Sport
Get Exercise Habbit

Fitness Down Under Questionnaire

If you would like to learn how personal training can help you accomplish your goals, fill out the following form. Click on the submit button when finished.

Name:

Contact Information

Phone:

E-mail:

would you like to be contacted?

Current Health Conditions

High Blood Pressure:

Yes

If yes...

High Cholesterol:

Yes

If yes...

Diabetes:

Yes

If yes...

Heart Disease:

Yes

If yes... Describe:

Do you smoke?

Yes

Height:
Weight:
Age:

If you are under the age of 18 you must have parental consent for training.

Please list any other known medical conditions you currently have or have been treated for in the past five years.


Please list any current or past injuries.


Please write a brief summary of your previous or current exercise history.

Nutritional Habits

How many ounces of water do you drink a day?

How many times a week do you eat out?


What would you like to learn more about in the field of nutrition?


Please describe your goals and if there is a target date you wish to accomplish them by.

We like to hold an initial consultation with you, before beginning personal training. This gives us an opportunity to talk with you about your goals and establish a strategy to reach them. We generally like to set this consultation time either over the phone or in person at a time when you could work out. Would you please indicate a time of day and day you might be able to work out.

Preferred Day(s):

Preferred Time(s):

Fitness Down Under, PO Box 158072, Nashville, TN 37215

Phone: (615) 336-9994

E-mail: info@fitnessdownunder.net

Fitness Questionnaire Form