Personal Training Request Name* First Last Date of Birth*Email* Cell PhoneHome PhonePreferrend Workout DaysSelect all that apply. Sunday Monday Tuesday Wednesday Thursday Friday SaturdayPreferrend Workout TimesSelect all that apply. Mornings Afternoons EveningsPreferred TrainerPlease enter name of trainer in the other field if requesting a specific trainer.FemaleMaleNo PreferenceAre you over 65 and/or not accustomed to vigorous exercise?*YesNoDo you frequently have pains in your heart and chest?*YesNoDo you often feel faint or have spells of severe dizziness?*YesNoHas a doctor ever said that you have high blood pressure?*YesNoHas a doctor ever told you that you have a bone or joint problem that is aggravated by exercise?*YesNoIs there any physical reason not mentioned here why you should not follow an activity program even if you wanted to?*YesNoPlease explain any medical conditions or rehabilitation issues you may have:What are your specific training goals? (Weight loss, cardiovascular fitness, strength building, etc)?How many days a week would you like to train with your trainer?Please enter between 1 & 7Please enter a number from 1 to 7.CAPTCHA