New Client Training Assessment – We Train With Mike Ford

Please fill out the form below.

To train with "Mike" please read the paragraph below... At "We Train With Mike Ford", we take your health and training very serious. We would like to begin our initial assessment by getting a few pieces of information listed below...

Which training package are you interested in?

Please select ONLY one package, in any event you accidentally select more than one, please click the "Start Assessment" link to reset form.
Pro Training Packages
Platinum Training Package ($1700)Gold Training Package ($1340)Silver Training Package ($980)Bronze Training Package ($620)
30 Minute Training Package
1 Session | 30 Minutes | 40.00 | 160/Month | 4 Month Minimum2 Session | 30 Minutes | 35.00 | 280/Month | 4 Month Minimum3 Session | 30 Minutes | 30.00 | 360/Month | 4 Month Minimum
One-Hour Training Package
1 Session | 60 Minutes | 70.00 | 280/Month | 4 Month Minimum2 Session | 60 Minutes | 60.00 | 480/Month | 4 Month Minimum3 Session | 60 Minutes | 50.00 | 600/Month | 4 Month Minimum
Group Rate Training Packages
2 People | 60 Minutes | 47.00 | 12 Sessions3 People | 60 Minutes | 37.00 | 12 Sessions4 People | 60 Minutes | 30.00 | 12 Sessions

Tell me more about you.

Date *
Name *
Address *
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Home/ Work Phone *
Email
Age *
Height *
Current Weight *
Ideal Weight *
Current Body Fat %
Ideal Body Fat %
Emergency Contact Name *
Emergency Contact Phone *
Health Awareness Regular exercise is associated with many health benefits. Increasing physical activity is safe for most people. However, some individuals should check with a physician before they become more physically active. Completion of this questionnaire is a first step when planning to increase the amount of physical activity in your life. Please read each question carefully and answer every question honestly:
1) Have you been a member of Mike Ford Personal Training before? *
YesNo
2) Have you been exercising regularly for the past 6 months? *
YesNo
3) During your last program did your progress slow dramatically after the first few weeks? *
YesNo
4) Have you ever used a Personal Trainer? *
YesNo
5) Do you smoke? *
Light (1-5 cigerettes per day)Moderate (5-12 cigerettes per day)Heavy (12-20 or more cigerettes per day)Not at all
6) Do you drink? *
LightModerateHeavyNot at All
7) How long did you keep your last health club membership while not using the facility? *
1-12 months1-2 years2-5 years
8) Please list the habits you would like to change: *
9) What are your physical goals? (please be specific) *
10) When was the last time you were at your ideal physical shape? *
11) What activities have you been participating in to achieve your goals? *
12) What events in your life are coming up that will motivate you to reach your goals? *
13) Why is it important to reach your goals now? *
14) After reaching your goals, how will your life be different? *
15) Over the past 10 years how many times have you started and stopped a nutrition and exercise regimen? *
1-56-1011-1516-20Too many to count
16) What external factors have derailed your progress in the past? (Check all that apply) *
TimeMoneyNo facilityProcrastinationLack of Support
17) In your own opinion, why did you fail to “stick with it”? (Check all that apply) *
DisciplineKnowledgeExperienceAccountabilityLack of expertise
19) On a scale of 1 – 10, how serious are you about achieving your goals? *
12345678910
18) I would like to: (check all that apply) *
Lose WeightGain WeightFeel BetterLook BetterLive Healthier
20) Are there any other conditions (injuries, medical illnesses) that your trainer should be aware of? *
If you answered yes to any of the above questions, please read the statement below. If you answered yes to any of the above questions, please read the statement below. If you answered yes to any of the above questions, talk with your doctor before you become more physically active. Tell your Doctor your plan to exercise and to which questions you answer yes. If you honestly answered no to all questions you can be reasonably certain you can safely increase your level of physical activity gradually. If your health changes so you then answer yes to any of the above questions, seek guidance from a physician.
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I have read the above statement, and agree.

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Which training package are you interested in?

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OUR TRAINING PACKAGES

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