Step 1 of 8 12% Please fill out these questions thoroughly and completely, as it helps the personal trainer understand your life and lifestyle, which will help them create a fitness plan that will fit your needs and goals. Client InformationAll information received on this form will be treated as strictly confidential. Please fill out the forms completely and accurately as this information is essential to helping me develop a program that addresses your needs, goals and interests that is safe and effective.What trainer will you be seeing?(Required)Select TrainerAndrew McmillanBrenda ShaughnessyCam HoodCaroline Van EgterenEthan WollmannGrant FreemanJoel BrissardJordan GallaugherJordan JohnsonMonique BussiereNino CruzSarah RiskeScott BisbeeShawn GoodmanPlease choose the name of the trainer your assessment is booked with. How did you find out about us?WebsiteSearch EngineFacebookTwitterInstagramYouTubeTVNewspaperReferralName(Required) First Last Address Street Address Address Line 2 City Province Postal Code Work PhoneHome PhoneCell Phone(Required)Email(Required) Enter Email Confirm Email Is email an acceptable method to contact you? Yes No Would you like to be opted-in for our newsletter, which will have information on specials, small group training schedule, recipes, etc? Yes No OccupationHeightWeightDate of Birth MM slash DD slash YYYY AgePlease enter a number from 0 to 120.Emergency Contact Name(Required) First Last Emergency Contact Phone Number(Required) PAR-Q FormPhysical Activity Readiness QuestionnaireHas your doctor ever said that you have a heart condition and recommended only medically supervised physical activity?(Required) Yes No Do you frequently have pains in your chest when you perform physical activity?(Required) Yes No Have you had chest pain when you were not doing physical activity?(Required) Yes No Do you have a bone, joint or any other health problems that cause you pain or limitations that must be addressed when developing an exercise program (i.e. diabetes, osteoporosis, high blood pressure, high cholesterol, arthritis, anorexia, bulimia, anaemia, epilepsy, respiratory ailments, back problems, etc.)?(Required) Yes No Are you pregnant now or have given birth within the last 6 months?(Required) Yes No If you have marked YES to any of the above, please elaborate below:Do you take any medications, either prescription or non-prescription, on a regular basis?(Required) Yes No What is the medication for?How does this medication affect your ability to exercise or achieve your goals? Lifestyle Related QuestionsDo you smoke? Yes No Do you drink alcohol? Yes No If yes, how many glasses per week?Please enter a number from 0 to 100.How many hours do you regularly sleep at night?Please enter a number from 0 to 12.What time does your day end? Hours : Minutes AM PM AM/PM What time does your day start? Hours : Minutes AM PM AM/PM Describe your jobDoes your job require travel? Yes No On a scale of 1 to 10 rate your stress level1 - Very low2345678910 - Very highList your 3 biggest sources of stress.1) 2) 3) Exercise Related QuestionsSkip to the next section if you are presently inactive.How often do you take part in structured exercise? 5-7 time per week 3-4 times per week 1-2 times per week If your participation is lower than you would like it to be, what are the reasons? Lack of interest Illness / injury Lack of time Other reason for your participation being lower than you would like it to beWhat activities are you presently involved in?(Please list ALL activities (sports, strength training, cardio, martial arts, aerobic classes, yoga, Pilates, etc.) and include frequency per week, average length of session/class).Please list activities (other than above) that interest you:Where are you currently training? Please provide the name of the facility:Does your current / future facility have the following equipment?Free Weights (Dumbbells) Yes No Barbells Yes No Machines Yes No Medicine Balls Yes No Stability Balls Yes No Bosu Ball Yes No Resistance Tubing / Bands Yes No Cable Pulley System ('Cables') Yes No When do you prefer to exercise / train?Realistically, how many times a week TOTAL can you COMMIT to exercise?Please enter a number from 0 to 20.Realistically, how long can you COMMIT to exercise for each session?Any further comments about your current and future exercise regime: Goal SettingHow can I, as your personal trainer, help you? Please list your goals and be SPECIFIC – the more details the better!Please list in order of priority, the fitness goals you would like to achieve and the time period you would like to achieve them. BE SPECIFIC. (i.e. Do 10 perfect push ups in 2 months)Where do you rate health, wellness and fitness in your life?Low priorityMedium priorityHigh priorityOutline what you feel are the obstacles or your potential actions, behaviours or activities that could hold back your progress towards accomplishing your goals (i.e. not training consistently, upcoming vacation, busy season at work, not following the program, allowing other responsibilities to become a priority over exercise etc.).Is there anything you want to share that will assist me in training you and helping you become successful in your fitness and wellness goals?If someone referred you to us, please state their name COVID SCREENINGI confirm that I am NOT experiencing any of the following: fever or chills coughing shortness of breath decrease or loss of taste and/or smell sore throat runny or stuffy nose extreme fatigue nausea, vomiting and/or diarrhea I confirm that I have NOT tested positive for COVID-19 in the last 5 days. I confirm that I have NOT had close contact with someone who has tested positive for COVID-19 in the last 5 days. I confirm that I am NOT living with someone who is currently isolating because of a positive COVID-19 test. I confirm that I am NOT living with someone who is currently waiting for the result of a COVID-19 test. I confirm that I am NOT currently waiting for the results of a COVID-19 test. I confirm that the above statements are true. Yes Create your accountBy creating your SVPTfitness.com account you will be able to login and view and change your account details, purchase sessions and view your order history. Username(Required)Password(Required) Enter Password Confirm Password Strength indicator
