Self Assessment

Personal Training Self Assessment

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Name *

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Phone Number *

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1. What are your goals for training? Fitness, health, lifestyle, specific distance or time, etc… *

1a.Do you have any injuries, chronic pain or movement limitations? Specifics are very helpful. *

2. What are your long term goals for fitness, health and/or lifestyle? *

3. What is your fitness background? What is your current weekly workout plan? *

3a. What days and times will you commit to working out? *

What fitness equipment do you have access to at home and/or a gym? *

5. How did you hear about Keep Moving Mama? If it’s a friend, include her name so we can thank her. *

6. How many servings of fruits & vegetables do you eat each day? *

7. How many ounces of water? *

8. Anything else your trainer should know? *

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Once you click SUBMIT you'll receive a call from us within 24 hours.

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