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Survey Maker

Personal Training Questionnaire

* Indicates required information

Please provide the following information to help us best serve you.

First Name *
Last Name *
Email *
Phone *
Year of Birth (yyyy) *

1. *
Are you currently a Wellness Center member?
      
2. *
Are you currently exercising?
      
3. *
Briefly describe your program (cardio and strength):
4. *
List your top 5 fitness goals.
5.
Please list any medications you are taking.
6. *
Do you have any limitations and/or restrictions that you are aware of?
7. *
What days and times would you like to meet a trainer? Choose any that apply.
8. *
Do you have a preference for a male or female?

Authentication *
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