Personal Training Consult Form This training form will be completed during the initial consult before a driver starts their personal training packages. "*" indicates required fields Personal Training Consultation Questionnaire-Around 1 hour to finishName* First Last Phone*Email* Inform the driver/in-house associate that workouts will be delivered via email so it must be a valid email address and one they look at oftenDriver/In-House Associate Username/Code* Truck # (if driver) Date of birth* MM slash DD slash YYYY Gender Male Female I'd rather not answer Height* Feet and inchesWeight*PoundsWhat type of driver or associate are you?* Team Solo Trainer PSD/TNT Student In-house What division do you work in? Tanker Reefer Flatbed Intermodal PSD/TNT student In-House Are you a current cigarette or tobacco user?* Yes No No, quit within the last 6 months Yes, but would like to quit in the next 6 months Do you suffer from any of the following conditions? High blood pressure High blood sugar Sleep apnea High cholesterol Please select all that applyDo you have any injuries or past surgeries that could effect your ability to workout?* Yes No Please list previous/current injuries or surgeries here Why did you sign up for our personal training service?*Outline what you feel are the obstacles or your potential actions, behaviors, or activities that could impede your progress towards accomplishing your goals (i.e. not training consistently, upcoming vacation, crazy work schedule, allowing other responsibilities to become a priority over exercising, etc.)Please list in order of priority, the fitness goals you would like to achieve in the next 3-12 months...Fitness goal #1* Why this goal #1?* Fitness goal #2 Why this goal #2? Fitness goal #3 Why this goal #3? Write any goal details here. For instance how many pounds do they want to lose? Nutrition goals? Sleep goals? This is a place for details.Would you like a referral to our DHF Dietitian for a nutrition assessment to go along with our training sessions?* Yes No Training Program detailsWe have a few different methods for personal training. Please pick which you want to do with your current training package.* "Follow along" training where a trainer works out with me (Explain that these are appointment based and offered 8am-5pm Mon-Friday) Having workouts written for me w/demonstration videos so I can do them on my own time (Explain that these are not appointment based and are the preferred option) In-person personal training (mostly for in-house) How many workouts would you like us to write for you each week?* 1-2 workouts 3-4 workouts More than 4 workouts How long do you want each workout to last?* 10-15 mins 20-30 mins 30-45 mins 45 mins-1 hours Where will you be doing your workouts?* Primarily in-truck Primarily out of truck Both in and out of truck At a fitness center or gym At home What is your workout experience level?* Brand new to exercise (Less than 6 months experience) Semi-experienced (6 months to 1 year) Experienced (1-2 years) Very Experienced (More than 2 years) What equipment will you be training with? Please check all that apply.* Just bodyweight Kettlebells Dumbbells Jump rope Resistance Bands I go to a fully equipped gym or fitness center for my workouts If using exercise equipment other than what was previously listed please list them here... Accountability Check-InsWe offer periodic check-ins for this service to make sure you are reaching your goals. The following questions are based on this portion.How should we reach out to for these accountability check-ins?* Phone call Qualcomm (Driver only) AS400 (In-house only) Email How often would you like us to check up on you through our accountability check-ins?* Weekly Bi-weekly Monthly ConclusionNow that the client has gone through the consult, explain how the virtual or in-person fitness assessments work. Virtual assessments will be done by the client only on their own, whereas in-person client assessments are best done monitored by the trainer.