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EveryBodyFIT Personal Training

Whether one on one, two at a time, or with a group, personal training typically consists of meeting with a fitness professional in the weight room to get a workout you normally would not perform on your own. Personal trainers can be used to learn new exercises, push you harder than you normally would by yourself, increase your accountability to improve your success with goal setting, or sometimes simply to do the thinking for you after a long day of work. Training with us includes all of these things and more. Please read on below to find out the services we offer.
Assisted stretching is included.
1-on-1, partner, and group fitness training sessions are available.
Contact us for details.

 
Assisted stretching is included.
Why personal train? Proper (and S.A.F.E.) exercise instruction, accountability, and motivation are just a few of the reasons.
Assisted stretching is included.
While most workouts end with stretching, 30 minute flexibility
sessions are also available.

FREQUENTLY ASKED QUESTIONS

How many sessions does it typically take to establish a program?
Everyone is different, as it depends on your experience, and overall "comfort level" in the gym, performing various exercises, etc. Also, if motivation and accountability is something to be worked on, this may increase the need for a few follow up sessions with you. You can "use us as much as you can or need to". We will discuss this, and we NEVER pressure anyone into purchasing extra sessions. When you fill out the Questionnaire, you can guess-timate how many times you may need.

Do you offer nutritional consulting?
We offer consulting, guidance, and tips. We will sometimes review food journals, but we do not write complete nutritional programs. "Proper" nutrition can account for 75% of the battle towards reaching your goals, so we will discuss nutrition at length. If we feel you need further guidance from a nutrition professional, we will recommend a Registered Dietitian of whom we work with regularly to provide the most complete and collaborative guidance possible.

Do I need a medical clearance to personal train with you?
In some cases. we will have you fill out a "PAR-Q" (Physical Activity Readiness Questionnaire) prior to training designed to identify the small percentage of individuals for whom physical activity may be inappropriate or should have medical advice concerning what physical activity is appropriate for them. Also, if you have been recently released from cardiac rehabilitation, or certain orthopedic therapy, we will ask you for a medical clearance. We will discuss this before hitting the weight room.

I'm not a member at the Richmond Heights Community Center , can I still work with you?
Absolutely! This costs an additional $7.00 to be paid at the front desk.

Do you offer "in home" personal training?
Yes we do. A few of our trainers maintain schedules with the flexibility required to service clients 'in home'. Email us directly to discuss your goaks, situation, and where you live to work this out. The fee for in home training is higher due to mileage and time taken to and from.

(If you have any other questions not addressed here, please, Click Here to email and ask Head Trainer Dave Reddy. Thank you.)

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MEDICAL / EXERCISE HISTORY & LIFESTYLE QUESTIONNAIRE

Thank you for taking the time to fill out our questionnaire, and please, keep in mind, the more you tell us, the better job we can do individualizing your fitness program. This questionnaire helps to maximize our time efficiency with you, especially during our first meeting, allowing us to follow up with specific details about what you are hoping to receive from our services. Thanks again, we look forward to meeting you, and will be contacting you as soon as possible.

Contact Information

Last Name

First Name
   
Work Phone

Home Phone

Mobile Phone

Email
                    

How did you hear about our servies and/or web site?

Online Search Referral Inquiry at THE HEIGHTS Other

Personal / Lifestyle Information
Gender   Male Female

Age    Birth Date     

Height  ft in

Has your body weight fluctuated in the past 1-5 years? 

What was your weight at age 18? lbs

How may hours of sleep do you typically get a night?

Do you or have you smoked?  Yes No  If so, when, and how many a day?
Do you live with someone who smokes?  Yes No

Do you drink alcoholic beverages?  Yes No  If so, which do you consume, and how much of each? (Click all that apply below:)
 

Comments:

Do you travel often for work?  Yes No  If so, how often, and does it have an effect on your exercise?

Did someone refer you or recommend you begin exercising?  Yes No 
If so, who? Doctor Friend Sibling Spouse Other

Exercise History
Are you currently involved in a regular exercise program?  Yes No

How often do you exercise?  (Exercise, for now can be defined as any consistent physical activity, i.e. walking, jogging, lifting weights, or rec sports lasting more than 30 minutes continually at a time.) 
Never Rarely 1 x / week Several x / week Daily

Workout Venue    Fitness Center or Health Club Home Outside (Walk/Run) Other
What fitness center or "other venue"?
                   
How long have you been a member at your present health club / fitness center?

What does a typical workout consist of?  (This can be any consistent physical activity you participate in.) Click all that apply, then please comment in the box below to give me an idea of a typical workout:

Walking outside 
Treadmill
Elliptical Machine
Stationary Bike
Walking Track
Swimming
Aerobics Class
Jogging / Running

Cybex Machines  
Free Weights
Stretching
Recreation Sport
Yoga
Pilates
I really don't have a typical workout, hence, I called you.  
Other (comment below)

"Typical Workout" Details"

Tell me about your very last workout (Continue below or tell me more yourself): 


How long did your workout last?  

What did you do, more or less? (Choose all that apply by Ctrl-clicking each selection) 

What was your focus? (Choose all that apply by Ctrl-clicking each selection)

Please include any other useful details below: (i.e. did you feel better or worse at the end of the workout?)

Physical Activity Readiness Questionnaire (PAR-Q)
For most people, physical activity should not pose any problem or hazard. PAR-Q has been designed to identify the small number of adults for whom physical activity might be inappropriate or those who should have medical advice concerning the type of activity most suitable for them. Please read and check the yes or no opposite the question.

Yes  No Has your physician said you have a heart condition or should only do exercises recommended by a physician?
Yes  No When you do physical activity, do you feel pain in your chest?
Yes  No When at rest, or not doing physical activity, have you had chest pain in the past month?
Yes  No Do you ever lose consciousness or do you lose your balance because of dizziness?
Yes  No Are you currently taking prescribed medications for your blood pressure or heart condition?
Yes  No Are you over the age of 65?

*If your health changes and answers above are altered, please notify your personal trainer, and we will discuss seeking guidance from a physician.

Personal Medical History
Do you have any allergies?  Yes  No
Do you take any medications for these allergies?  Yes  No
If you do take medications, please list them below.

Do you take any "over the counter" non-prescribed medications daily? (i.e. Aspirin, Tylenol)  Yes No

Have you had any surgeries that may have an effect on your exercise performance?  Yes  No
List and briefly describe below:


Do you have any other aches and pains (i.e. low back) that hinder or may hinder your exercising?  Yes No

Have you ever been diagnosed with, or experienced any of the following? (Click all that apply)

Rapid / Irregular Heart Beat
Hypertension
Calf pain with exercise
Varicose veins
Stroke		 High blood cholesterol
High blood triglycerides
History of blood clots
Shortness of breath
Glucose Intolerance

Do you take medications for any of the conditions selected here?

If you are over the age of 60, have you had a bone density test recently? Yes No

Family Medical History
If known, please click on all of the following conditions your parents, grandparents, or siblings have or have had:

Hypertension
Cancer
Diabetes
Stroke
Heart Attack
Other Heart Blockage / Problems		 Obesity
Arthritis
Osteoporosis
Asthma
Anemia
Epilepsy / Seizures

Questions for FEMALES Only
Have you ever been pregnant?  Yes No  If so, how many times?

Are you currently expecting?  Yes No    If so, (Congratulations!) what is the present due date?       

Do you have regular menstrual cycles?  Yes No

Are you Pre-menopausal Post-menopausal

Goals Overview (Select all that apply)

Improve exercise habits 
Learn more about my body
Learn more about nutrition 
General fitness
Weight management    
Upper body strength
Lower body strength
Improve flexibility
 Improve posture
Get in shape for event
Lifestyle change
Just had baby . . .
Sport specific training
Increase muscle size 
Wanting more energy 
Other (explain below)

Please add any other goal related specifics (in your own words) below:

In a nutshell, what motivates you?  What motivates you to work towards the goals listed above?  What has motivated you in the past?


Please discuss any specific motivators above, and check anything that may apply, included in the list below:

Overall health benefits
Group (support) settings (T.O.P.S., Wt. Watchers, etc.)
Looking at old pictures of your self
Positive reinforcement
Negative reinforcemet
 Hearing others success stories (on TV, friends)
Reading motivational articles, books            
Success or previous success on the playing field
Desire for a better quality of life                       
Desire to keep up with the kids (grand kids)

What has happened, if ever in the past, that may have caused you to lose this motivation, or fall off track?
Did not see any results
Got bored
Not enough direction, not really sure what to do or how to progress with exercise
Personal life experience (Career change, had baby, injury, other)
Too busy with work and/or family, (long hours, lots of travel, family obligations)
It just happened, I don't really have that great of an excuse
Anything else? Please explain:

Commitment
How many days a week can you or are you willing to commit to these goals?  (Give or take a day)  

How much time do you have per workout session?

The EBF Personal Trainers are here to help you as much as you can or want, therefore, how many times do you think you'll want to meet to get you on track?
 

Nutrition
How would you rate your nutritional habits as of today? 

Do you normally eat breakfast? Yes No     

What was your breakfast this morning?  Is this typical?

Are you a vegetarian?  Yes No

How many meals do you typically eat in a day? (A snack is considered a meal.) 

How much caffeine do you consume daily?  (Cup of coffee = 100 mg , 12 oz soda = 50-60 mg , tablet = 200 mg)
                          None 50-100 mg 100-150 mg 200+ mg Not Sure

What form is it in?  Coffee Regular Soda Diet Soda Tea Energy Drink Other

How many times do you eat out a week? 

Do you or have you supplemented with any of the following (Check all that apply):

Multi-vitamin
Individual vitamins / minerals
Protein powder
Herbal supplements
"Energy supplements"
Supplements for joint support 
 Creatine
Amino acids
"Fat Burners"
"Fat Blockers"
Fiber supplement
Other

Can you tell us a little bit about the supplments you take, i.e., type of protein, what individual vitamins, what brand fat burner?

How would you describe your "nutritional focus"?
I have no nutritional focus 
Low Fat 
Low Carb 
Everything in moderation
Small portion sizes
Grilled chicken & spinach during the week, wings and beer on the weekend
Other (Explain below):

Do you follow, or have you followed a specific diet?  If so, check the appropriate one and explain below.
South Beach  Atkins  Weight Watchers  Jenny Craig  Zone Diet  40-30-30
Other

Fitness Information
Where do you get most of your health and fitness information?  (Click all that apply.)
Fitness Magazines Internet Newspaper Doctor Other Magazines TV
Book(s) Other

Have you ever ordered a fitness product online? (Book, DVD, Exercise Equipment)

Scheduling An Appointment / Availability
Appointments are available, 6 days a week, Monday to Saturday, ocassionally on Sunday, but many time slots are scheduled far in advance.  Therefore, let me know a few available hours and or days that are good for you.  (Click all that apply by holding down the Ctrl button while you select.)

Days


Time Slots


Let me know if you have any other questions or comments.

Thank you for taking the time.  Please click the SUBMIT button only once, it may take a minute to process.

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