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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 finish

Name*

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 often

Driver/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 inches

Weight*

Pounds

What 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 apply

Do 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 details

We 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-Ins

We 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

Conclusion

Now 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.

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(417) 521-3473

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2740 N Mayfair Ave, Springfield, MO, 65803

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