You must have JavaScript enabled to use this form. Hi Coyotes! All members have access to ONE complimentary session with a certified personal trainer. During this one-hour virtual session, members will go over a health & lifestyle questionnaire, goal setting, a series of optional fitness assessments, and decide whether to move forward with personal training. Personal Training Inquiry Form Name: Affiliation: Email Address: Home Phone: Work/Cell Phone: Weekly Availability: Please write in the times you are available to meet with us each day. Monday Tuesday Wednesday Thursday Friday Saturday Trainer Preference: - Select -MaleFemaleNone Requested Trainer: Interests In order to provide you with the custom experience that you are interested in receiving, please check all that apply: Fitness Consultation Fitness Assessment Gym Orientation Exercise Program Design Personal Training* Group Exercise Other… Enter other… *Personal Training is an additional fee, only check if you are interested in personal training Lifestyle Questionnaire What types of exercise interest you? Walking Jogging Strength Training Cycling Traditional Aerobics Cardio Equipment Racquet Sports Yoga/Pilates Swimming Other… Enter other… What is your present occupation? Does your occupation require much activity? - Select -YesNo Can you exercise during your work day? Explain: Would an exercise program benefit your job? Explain: Would an exercise program interfere with your job? Explain: What are your usual leisure activities? What types of things make you feel stressed? How do you deal with your stress normally? How many meals and/snacks do you have per day? What would you estimate your caloric intake is per day? Do you feel you eat healthy “most of the time?” - None -YesNo When do you usually eat your last meal and/or snack of the day? Goals Rank you goals in undertaking exercise: what do you want exercise to do for you? (1=Strongly Disagree; 2=Mildly Disagree; 3=Neutral; 4=Mildly Agree; 5= Strongly Agree) 1. Improve cardiovascular fitness - Select -12345 2. Lose weight/body fat - Select -12345 3. Increase weight/lean muscle mass - Select -12345 4. Improve performance for sport - Select -12345 5. Improve ability to cope with stress - Select -12345 6. Improve flexibility - Select -12345 7. Increase strength - Select -12345 8. Increase energy level - Select -12345 9. Feel better - Select -12345 10. Increase enjoyment of exercise - Select -12345 11. Social Interaction - Select -12345 Is there any other information you would like to share with us at this time?