10210 S Dolfield Rd Owings Mills, Maryland

410-356-2169

6 reasons why us
The Only Personal Training Studio in Owings Mills with Guaranteed Fitness & Weight Loss Results!
Personal Training RX HOME

Dr. Ray Hinish

Natural Pharmacist, Certified Personal Trainer & Owner.

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Owings Mills Baltimore Maryland Guaranteed weight loss fitness center
Home | Getting Started
Personal Trainer Owings Milss Maryland Get Started

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Please fill out and submit this questionnaire and we will contact you to set up a free consultation within the next 24 hours.

 

Personal Training Rx is currently only accepting a limited number of clients to workout in our private studio.

 

All sessions are by appointment only and clients are selected through this questionnaire.

 

Fitness Questionnaire

Please fill this questionnaire to apply for a free consultation or to join our fitness studio.

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1. Your Personal Information

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First and Last Name *
Email Address *
Address *

Street

Apt/Suite/Floor
City

State

Zip Code

    
Phone Number (Home) *
Phone Number (Work)  
Spouse's Name  
Occupation  
Age *
     

2. Interests & Goals

Select all that apply.
 

Other:

     

3. Past & Present Medical History

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Blood Pressure
Heart Problems
Diabetes
Fatigue
Anxiety
Arthritis
Bursitis
Muscle Tension
Knee Problems
Shoulder Problems
Tendon / Joint Problems

If yes, explain:
Back Problems

If yes, explain:
   

4. Current Physical Condition

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Rate your current physical condition. 1 is poor, 5 is excellent.
1 2 3 4 5
Are you currently exercising? If Yes, please explain:
Current weight * (lb)
Weight 2 years ago (Estimate) * (lb)
Employment  
Outdoors activity or recreation  
Married  
Children  
     

5. Habit Tracker

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Eat 3 Meals per Day
Fast Food
Alcohol
Restaurant Food
Coffee
Smoke
Snacks
Soft Drinks
Watch TV
Take Supplements
8 hours Average Daily Sleep
   

6. Six Month Goals

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Arms
Legs
Waist
Chest
Heart Rate
Hips
Back
   

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