Online Personal Training Consultation Questionnaire

Full Name*

First NameLast Name

Gender*

MaleFemale

Date of Birth*

MonthDayYear

Age

years

Height

Ft. inches

Weight

Lbs

E-mail*

How did you find me?*

If you chose referral, who referred you?

Preferred Method of Communication*

Please provide preferred contact information:

What do you do for a living?

*So I know the type of stress you're under on a daily basis*

Whats the activity level at your job?

none(seated only)Moderate (light activity such as walking)High (heavy labor, very active)

Do you follow a regular working schedule, do you work days, afternoon or nights?

How often do you travel?

RarelyA few times a yearA few times a monthWeekly

Please list the physical activities that you participate in outside of the gym and outside of work.:

If you have any diagnosed health problems list the condition(s).

If you are on any medications, please list them.

What additional therapies are being undertaken for the given health problem(s)?

If you have any injuries, please list them.

What additional therapies are being undertaken for the given injury?

Are you cleared from your doctor for physical activity?

YesNo

Are you experiencing any stresses or motivational problems?

YesNo

Has anyone of your immediate family developed heart disease before the age of 60?

YesNo

Do you suffer from diabetes, asthma, high or low blood pressure?

YesNo

if yes please list:

Are you a current cigarette smoker?

YesNo

Your current nutrition plan could be best characterized as:

If neither, please describe your current nutrition plan as best as you can:

Please rate your readiness for change. (1-least ready, 10-totally ready)

Which of the following best describes what you want to accomplish?

If the previous descriptions doesn't do justice, please write a brief description of what you want to accomplish.

Why do you want to accomplish these goals. Please be explicit.

Timeline for achieving your goal.*

	12 WKS	16 WKS	24 WKS	32 WKS	40 WKS	1 YEAR	It'll take more than a year
NOW

Are you currently excersising regulary (at least 3x per week)?

YesNo

Have you trained with a personal trainer before?

YesNo

If yes what kind of training did you do:

At what times during the day would you prefer to train?

MorningMid-DayAfternoonEvening

What are your expectations of me as your Personal Trainer?

How often do you want to do Personal Training a week?*

Please Choose

Are you apart of a gym?

YesNo

If no, please list what equipment you currently have access to prior to beginning your training program?

Are You Number 1 In Your Life?*

YesNo

If no, please list what is in the order of importance as best as you can?

Which Service Would You Like to Invest in?*

Remote/Online Training OnlyRemote/Online Training w/ Nutrition Coaching"Face to Face" ZOOM/SKYPE Personal Training

Choose Your Package From TrainWithDonovan.com*

Level 1- Basic PackageLevel 2- Advance PackageLevel 3- PREMIUM Package

1.) 1. Eligibility

Minimum Age. You must be at least 18 years old to use the Site, and at least 18 years old to register for the Services. By using the Services, you represent and warrant that you are at least 18 years old. Other Services may have other age requirements for all or portion of such Services, and such other age requirements are stated on such Services or portions thereof.

2. Use of Site and Service

As a user of the Site or a user registered to use any of the Services (a "Registered User"), you agree to the following:

2.1. Exclusive Use. Your account is for your personal use only. You may not authorize others to use your account, and you may not assign or otherwise transfer your account to any other person or entity. You acknowledge that TRAIN WITH DONOVAN MULDROW is not responsible for third party access to your account that results from theft or misappropriation of your user names and passwords.

2.2. Geographic Limitations. The Site and Services are intended for use in the United States. You will only use the Services in a manner consistent with this Agreement and any and all applicable local, state, national and international laws and regulations, including, but not limited to, United States export control laws. You are not located in, under the control of, or a national or resident of any country which the United States has (i) embargoed goods, (ii) identified as a "Specially Designated National", or (iii) placed on the Commerce Department’s Table of Deny Orders. Registration for, and use of, the Services are void where prohibited. To the extent that the Services are not legal in your jurisdiction, you may not use the Services. The Services may not be used where prohibited by law.

2.3. Information Submitted. You are solely responsible for, and assume all liability regarding, (i) the information and content you contribute to the Service; (ii) the information and content you post, transmit, publish, or otherwise make available (hereinafter “post”) through the Services; and (iii) your interactions with other Registered Users through the Services.

2.4. Risk Assumption and Precautions. YOU HEREBY ACKNOWLEDGE THAT TRAIN WITH DONOVAN MULDROW MAKES NO WARRANTIES AND DOES NOT GUARANTEE INDIVIDUAL RESULTS. YOU, NOT TRAIN WITH DONOVAN MULDROW, ARE PERSONALLY RESPONSIBLE FOR THE ACHIEVEMENT OF INDIVIDUAL PERFORMANCE GOALS. YOU FURTHER UNDERSTAND AND ACKNOWLEDGE THAT PHYSICAL EXERCISE IS INHERENTLY DANGEROUS AND CARRIES WITH IT THE POTENTIAL FOR DEATH, SERIOUS INJURY AND PROPERTY LOSS. YOU UNDERSTAND AND AGREE THAT YOU ASSUME THE RISK OF PARTICIPATING IN THE TRAINING AND ACTIVITIES RECOMMENDED BY TRAIN WITH DONOVAN MULDROW, ITS AGENTS AND REPRESENTATIVES. YOU HAVE NOT BEEN ADVISED AGAINST PARTICIPATION IN A PHYSICAL EXERCISE PROGRAM BY A QUALIFIED HEALTH PROFESSIONAL.

2.5. Photo/Video Release: You hereby grant TRAIN WITH DONOVAN MULDROW permission to use my photograph/video image in any and all publications for TRAIN WITH DONOVAN MUDLROW, including web site entries, without payment or any other consideration in perpetuity. I hereby authorize TRAIN WITH DONOVAN MULDROW to edit, alter, copy, exhibit, publish or distribute all photos and images. I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my photo appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photograph or video images. I hereby hold harmless and release and forever discharge TRAIN WITH DONOVAN MULDROW from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf of on behalf of my estate which may have or may have by reason of this authorization.

2.5. Reporting of Violations. You will promptly report to TRAIN WITH DONOVAN MULDROW any violation of the Agreement by others, including but not limited to Registered Users.

2.6. Content Removal. TRAIN WITH DONOVAN MULDROW reserves the right, but has no obligation, to monitor the information or material you submit to the Services or post in the public areas of the Services. TRAIN WITH DONOVAN MULDROW will have the right to remove any such information or material that in its sole opinion violates, or may violate, any applicable law or either the letter or spirit of this Agreement or upon the request of any third party.

2.7. Posting and Communication Restrictions. Postings on the Content Services currently known as TRAIN WITH DONOVAN MULDROW Advice (“Advice”) will follow the terms of this Agreement. In addition to the foregoing, you will not post on the Services, transmit to other users, communicate any content (or links thereto), or otherwise engage in any activity on the Site or through the Services, that:

2.7.1. promotes racism, bigotry, hatred or physical harm of any kind against any group or individual;

2.7.2. is intended to or tends to harass, annoy, threaten or intimidate any other users of the Site or Services;

2.7.3. is defamatory, inaccurate, abusive, obscene, profane, offensive, sexually oriented, obscene or otherwise objectionable;

2.7.4. contains others’ copyrighted content (e.g., music, movies, videos, photographs, images, software, etc.) without obtaining permission first;

2.7.5. contains video, audio photographs, or images of another person without his or her permission (or in the case of a minor, the minor’s legal guardian);

2.7.6. promotes or enables illegal or unlawful activities, such as violate someone’s privacy, harm or harass another person, obtain others’ identity information, create or disseminate computer viruses, or circumvent copy-protect devices;

2.7.7. intended to defraud, swindle or deceive other users of the Services;

2.7.8. contains viruses, time bombs, trojan horses, cancelbots, worms or other harmful, or disruptive codes, components or devices;

2.7.9. promotes or solicits involvement in or support of a political platform, religion, cult, or sect;

2.7.10. disseminates another person’s personal information without his or her permission, or collects or solicits another person’s personal information for commercial or unlawful purposes;

2.7.11. is off-topic, meaningless, or otherwise intended to annoy or interfere with others’ enjoyment of the Site;

2.7.12. impersonates, or otherwise misrepresents affiliation, connection or association with, any person or entity;

2.7.13. solicits gambling or engages in any gambling or similar activity;

2.7.14. uses scripts, bots or other automated technology to access the Site or Services;

2.7.15. uses the Site or Services for chain letter, junk mail or spam e-mails;

2.7.16. collects or solicits personal information about anyone under 18; or

2.7.17. is in any way used for or in connection with spamming, spimming, phishing, trolling, or similar activities.

3. The minimum requirement for participating in this program is 3 months or 12 weeks. Any cancelation of the program prior of this 3 month minimum will void of any refund.

I AGREE TO THE ABOVE TERMS & CONDITIONS!*

YesNo

Train With Donovan Personal Training Questionnaire

Part 1. Basic information

Part 2. Lifestyle Information

Part 3. Medical and health information

Part 4. Goals

Terms and Conditions