Tri-State Fitness - Personal Training Throughout NY, NJ and CT


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Personal Trainers

Jason Keigher
Urban Fitness
Amazingly Fit
Surge Fitness
Fit Brides
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Tri-State Fitness is committed to finding you a compatible personal trainer, yoga/pilates instructor or nutritionist. This questionnaire will help us understand your needs and goals.

REQUIRED INFORMATION
Full Name:
Email Address:
Phone Number:
OPTIONAL INFORMATION
Street Address:
City:
State/Province:
Zip/Postal Code:
Country:

HEALTH AND FITNESS GOALS

What are your health and fitness goals? (be very specific)

Are you trying to diet and lose weight? yes no
If yes, how much do you want to lose? lbs.

What areas of fitness interest you? Strength training    Body Toning and Shaping
Weight Loss    Flexibility/Stretching    Yoga    Pilates    Body Building
Pre/Post Natal    Postural Correction    Nutrition    Other:

TRAINING LOCATIONS, TIMES AND DATES
Select the days you would you like to workout? Sunday Monday Tuesday Wednesday Thursday Friday Saturday
What time of day would you like to workout? 6-9am 9am-12pm 12-3pm 3-6pm 6-9pm 9-11pm Other:
Where will you workout? Gym/Health Club Home Other: If you will workout at home, what type of equipment do you have?
EXERCISE HISTORY
Do you currently exercise on a regular basis? yes no
If yes, describe the frequency, intensity, time and type of exercise routine:
MEDICAL HISTORY
List any injury or medical condition that may limit your ability to follow a fitness program:
MISCELLANEOUS
List any additional information, including specific trainers that you'd like to work with:
Thank you for filling out this questionnaire. We will notify you when we receive your information. If we need additional information we will call or e-mail.