Goals » Fit Over Fifty Fitness

Client Status and Goals Questionnaire

Name

Date

Age

Date Of Birth

GenderFM

Street Address

City

State/Province

ZIP / Postal Code

Country

Occupation

Cell Phone

Do you Text On Your Phone?YesNo

Email Address

Emergency contact name

Phone

Physician’s Name

Phone

Have you worked with a personal trainer before? YesNo

If yes: What did you like most about your experience?

What did you like least about your experience?

How did you hear about Fit Over 50 Fitness?

Anything else you would like to share?