TrainerizeTo get you started on your fitness journey with Trainerize, please fill out the information below. Name * First Name Last Name Email * Phone * (###) ### #### Date of Birth * MM DD YYYY Current Weight: * Current Height: * Gender * Male Female What are your short term goals for the next six months? Fat Loss Tone / Gain Muscle Get Stronger Improve Cardio Endurance What is your current cardio schedule, total weekly amount, and type? Eg. Elliptical, stair master, treadmill. * How many days per week are you currently attending the gym? * 0 1-2 Days 2-5 Days 5+ How would you rate your gym experience/knowledge ? * Beginner Intermediate Advanced What do you do for work? From a scale of 1-5 is it physically active or sedentary? (1 - sedentary, 5 - physically active) * 1 2 3 4 5 Do you have any injuries that may hold you back from performing a particular exercise? If so, please explain in detail. Do you have any medical conditions or taking any medications that would deter you from participating in particular exercise or cardio programs? If so please list all in detail. Do you have any allergies and or intolerances to any foods I should be aware of? Foods you enjoy? Do you prefer sweet or savoury ? * Foods you don’t enjoy? * How many meals do you prefer to eat ? * 3 4 5 Do you prefer to train in the morning/afternoon or evening? * Morning Afternoon Evening Please add any additional information you think I should know to help me make a plan most suitable to fit your life! 3 Day Food Journal Please take the next three days to document any foods and drinks without making changes to your regular eating habits. Any sauces, creamer etc. Please list in order from when you wake up to the last thing you eat in the day and times. Liability Waiver Before submitting the form, please read our Liability Waiver (this will open in a new window) By signing below, client acknowledges and warrants that he/she has read and understood this entire agreement (1 through 7) and that he/she agrees to be legally bound to the terms and conditions of this agreement. I read the Liability Waiver I consent Thank you! Please check your email for additional instructions on next steps and tracking your progress. If you’re ready to purchase a training package or schedule an appointment, please click here.I look forward to working with you! - Shailene
