Custom Training - Customized Program Application Part 1

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Welcome to the home of customized fitness programs - designed by Custom Training and delivered via the Web!

Reside in New Jersey? If you wish to be trained at our studio in Union, NJ, for more information.

It is never too late to get started on a fitness program and you will thank yourself for doing it in the long run! We customize exercise and nutrition programs for individuals based on their body type, metabolism, age, physical condition, health history, specific needs, specific likes and dislikes, etc. Everyone is unique, and we take that into consideration when designing our programs.

Click on each program name to learn more about it:

Exercise Plan
Nutrition Plan/Diet
Exercise and Nutrition Plan/Diet
Phone Consultation

If you are interested in receiving one of these fitness programs customized to your individual needs, we will need to know your physical fitness history. Please answer all of the questions below - the more detail you provide, the better we can tailor a program to meet your goals.

Contact Information
Your Name:
Your E-mail:
Program Customization
Sex:
Age:
Height:
Weight:
Frame Size:
What type of lifestyle do you have?
What are your goals?
To make multiple selections, hold down the Shift or Ctrl key while clicking.
Do you work out now?
How often do you work out?
If you are currently working out with weights, please describe what exercises you are doing, and with how much weight in pounds. If you do not currently work out with weights, type "None" in the box.
If you are currently doing aerobic exercise, what type of machine are you using, or what exercise are you doing, and for how long, and at what speed. If you do not currently do aerobic exercise, type “None” in the box.
What is the best time of day for you to exercise?
What type of training are you interested in participating?
To make multiple selections, hold down the Shift or Ctrl key while clicking.
Where do you currently work out?
If you work out at home, describe the workout equipment you currently use? If you do not work out at home, type “None” in the box.
If you work out at a gym/spa/health club, describe the workout equipment you currently use? If you do not work out at a gym/health club/spa, type “None” in the box.
What are some of the activities you enjoy doing? To make multiple selections, hold down the Shift or Ctrl key while clicking.
What are your goals and what do you wish to accomplish from this program?
Please describe your typical food intake in a 24-hour period. For example: Breakfast — slice of toast, fruit, coffee; Snack — piece of fruit or bread; Lunch — turkey sandwich; Dinner — piece of chicken with potatoes and salad.
How many meals do you eat in a typical day including snacks?
How often, per week, do you eat your evening meal at home (times per week)?
How often, per week, do you eat out (times per week)?
What type of food do you usually eat when you go out?
Health History
In order to design a safe and effective fitness program it is important that you complete the following Health History. It is crucial that you answer all the questions honestly and to the best of your ability. Please be advised that all information is kept strictly confidential. Has your doctor ever told you that you have heart problems?
Has your doctor ever told you that you have high blood pressure?
Have you ever suffered a stroke or heart attack?
Have you ever had pain in your chest?
Do you ever feel faint or have dizzy spells?
Have you had surgery in the last six months?
Select those medical conditions that apply to you.
To make multiple selections, hold down the Shift or Ctrl key while clicking.
Have you injured or have pain in any of the following areas?
To make multiple selections, hold down the Shift or Ctrl key while clicking.
If you checked any one of the areas above, please explain. If you do not have any injuries, type “None” in the box.

Are you currently taking any medications?
If you checked “Yes,” please list medications, dosage, and for what condition. If you do not take any medication, type “None” in the box.
Are you currently undergoing treatment from any of the following?
To make multiple selections, hold down the Shift or Ctrl key while clicking.
If yes, why? If you are not undergoing treatment, type “None” in the box.
How would you rate your level of stress on a daily basis?
What do you think your ideal weight should be?
Have you ever been your ideal weight?
If yes, how long ago? (If no, leave blank.)
Are you currently following any type of special diet?
If yes, please select which diet below:
If you checked other, please specify below. If you did not check other, type “None” in the box.
Estimate how many hours of sleep you get each night.
Are there any other reasons (health or personal) that may limit or prevent you from exercising?
If yes, please explain. If there are no other reasons, type “None” in the box.