©© Are you ready to kill it?…

Client Profile

Please assist me by filling out this brief questionnaire

Your Full Name:

Phone Number:

Email:

Home Address:

Gender:

Age:

Occupation and Workplace Location:

How did you first discover Killit Fitness?

Client Profile

What are you currently doing for exercise? (Please include frequency)

Have you trained with a personal trainer before, or on a coached sports team? (If yes, please explain)

Do you have a gym membership somewhere? (If yes, how much do you pay for a monthly membership)?

Do you prefer to train outdoors, in your home, a fitness facility, a combination of the above, or other?

How many days per week do you wish to train?

What do you hope I can help you achieve?

What dollar value per month do you place on your health and physical appearance? (Personal training, gym membership, nutritional plan and lifestyle guidance) :

($50-$100)($100-$150)($250-$350)($400-$600)

Client Profile

Please list your fitness goals in the categories that apply to your needs:

•Weight/Size :

•Physical Fitness Abilities :

•Internal Health & Bodily Functions :

•Nutritional :

•Events/Challenges/Sports-Related :

Do you have any Injuries or health issues that could affect your ability to exercise or maintain a diet?

Are you currently on any medications?

Do you smoke cigarettes or have quit smoking in the past 6 months?

Do you wish to train with a friend or alone? (Sessions can be administered with up to 3 people, and discounts will apply)!

Your Weekly Schedule

Time of Day

Mon Tues Wed Thurs Fri Sat Sun

Example 7am-8am

* * * * * *

Example 9am-5pm

Work(mon-fri)

Example6:30pm-10pm

* * * * * *

Please indicate with a star (*) the days and times you can potentially set aside for some form of exercise, whether it be training with a personal trainer, or doing something on your own. Please fill in the times in the left hand column as well. You may also write in any other daily commitments (such as work/school), to give me a better idea of how we can plan a healthier lifestyle for you).

Killer Packages

Killer Kick-Starter

-Consultation-Goal Setting

-Movement Screening-Exercise Program Design

-First Session (includes how-to, demos, explanations, form

correction, tips and tricks)-healthy lifestyle support

Lean & Mean

-Consultation-Goal Setting

-Monthly Measurements-Before & After Photos-Movement Screening

-Exercise Program Design-2 to 3 Personal Training

Sessions per week*(includes assisted workouts, stretches,

post-workout massage and roller)-Healthy lifestyle support

*3 sessions = added $40 charge per week

Killer Bod

- Consultation- Goal setting

- Monthly Measurements- Before & After Photos- Movement Screening

- Exercise Program Design- 2 to 3 Personal Training Sessions per week*(includes

assisted workouts, stretches, post-workout massage and roller)

- Nutritional Analysis- Dietary Needs Consultation

- Eating Plan by a Registered Dietician*- Healthy Lifestyle Support

*3 sessions = added $40 charge per week*1-Month Eating Plan

$150 flat rate

$320 / month

$600 / month

Measurements + Weigh-ins

Waist Abdomen Hips

Weight Body Fat %

Caliper Test

Bicep

Tricep

Side (rib)

Scapula

Stomach (navel)

Thigh

Calf

Pre-Training

*Example*

Weekly Goals

WEEK : / / to / /

WEEKLY GOALS : ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

STATEMENT OF COMMITMENT: ___________________________________________________________________________________________________________________________________________________________________________________________________

SpecificMeasurableAchievableRealisticTime-Bound

*Example*

BMR CalCuLator

SpecificMeasurableAchievableRealisticTime-Bound

Food + Beverage Tracker

Time of Day Mon Tues Wed Thurs

Total Calories

*Example*

Food + Beverage Tracker

Time of Day Fri Sat Sun

Total Calories

*Example*

Equipment

Weights Stabilizer Cardio Stretch Measures

Body Weight (TRX)

Stability ball Skipping Rope

Yoga Mat Scale

Barbell, Dumbbell

Bench Rebounder Stretch Band Tape Measure

Kettle bell Sturdy Chair Step-Up Roller Heart Rate Monitor

Medicine Ball Bosu Ball Elliptical Assisted Stretch

Weekly Improvement*Example*

Before + After Photos

Pre-training

*Example*