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Personal Training Request Form

Client Information

First Name

Last Name

Primary Phone

date

*Parental consent is required for minors.

How many times per week do you want to work with your personal trainer?

Time	Sunday	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday
AM
PM

If you have preferred times and days for personal training, please provide:

List your three main fitness/wellness goals:

What are your goals for personal training (weight loss, strength, cardiovascular fitness, etc)

How do you see the personal trainer helping you to meet your goals?