Let’s work together

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Two athletic individuals standing back-to-back, wearing workout clothes, smiling, with arms crossed, on a plain background.

A woman balancing on one leg, reaching forward with her arms, while a man stands nearby observing in a gym setting.

Two people exercising at a gym, doing side lunges with hands on hips, surrounded by punching bags and equipment.

A person lifting a dumbbell in a gym, receiving guidance from a trainer. The gym has a red wall, equipment, and a neon sign in the background.

Personal trainer guiding a client in a modern gym with exercise equipment in the background.

Name

First Name

Last Name

Phone

(###)

###

####

What services are you interested in?

Personal Training at Punch Fitness

Group Training at Punch Fitness

3 month Health and Wellness Coaching

Online Fitness Programing

At Home Personal Training

6 week lifestyle change program online

What is your budget?

Exercise

What exercise activities do you currently take part in (e.g., running, weightlifting, group exercise, etc.)?

How many days per week do you get at least 60 minutes of moderate-intensity exercise?

On a scale of 0 to 10, how important are the following fitness goals to you? Weight loss Muscle gain Sports Performance Health Improvement

Diet

On a scale of 0 to 10, do you consider your overall diet to be healthy?

Are you currently following any kind of diet? If so, what diet and for what reason(s)?

How would you rank your daily salt intake: low, medium, or high?

How would you rank your daily sugar intake: low, medium, or high?

How would you rank your daily fat intake: low, medium, or high?

How many alcoholic drinks do you consume per week?

Do you consume caffeinated beverages such as coffee, tea, soda, and/or energy drinks? How many per week?

Lifestyle and Health History Questionnaire

Do you feel like you get enough sleep and wake up feeling rested each day?

On a scale of 0 to 10, how would you rate your average level of stress?

What techniques do you currently use to manage your stress levels?

Do you smoke tobacco or use a vaporizer alternative?

Occupation

What is your occupation?

Does your occupation require extended periods of sitting? (If YES, please explain.)

Does your occupation require repetitive movements? (If YES, please explain.)

Does your occupation require you to wear shoes with a heel (e.g., dress shoes, work boots)?

Recreation

Do you partake in any recreational physical activities (golf, skiing, etc.)? (If YES, please explain.)

Recreation

Do you have any additional hobbies (gardening, fishing, music, etc.)? (If YES, please explain.)

Medical

Please list out any past musculoskeletal injuries:

Please list out any past surgeries:

If you have experienced injuries or surgeries, were they properly rehabilitated and did you receive clearance from a doctor to return to physical activity?

Additional notes

Let’s work together

AGELESS PERFORMANCE TRAINING