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Client Intake Form
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Name
*
First
Last
Email
*
What service are you enrolled in?
*
Personal Training
VIP Membership
Date of Birth
Phone Number
*
Emergency Contact Name
*
Emergency Contact Phone Number
*
What are your main fitness goals?
What would you like to achieve in the next 3 months?
What would you like to achieve long term?
Why are these goals important to you?
Have you worked with a personal trainer before?
Yes
No
Current activity level
Beginner
Somewhat Active
Active
Very Active
Do you have access to a gym?
Yes
No
Do you have any exercise equipment at home? If yes please list what you have (e.g. dumbbells, resistance bands, treadmill, etc.)
What types of exercise or training have you done before?
What exercises or workouts do you enjoy?
What exercises, workouts, or activities do you dislike?
Do you currently have any injuries, pain, or physical limitations?
Yes
No
If yes, please explain your current injuries or limitations
Have you had any previous injuries or surgeries?
Yes
No
If yes, please explain your previous injuries or surgeries
Do you have any current or past health conditions?
Yes
No
If yes, please explain your health conditions
Are you currently taking any medications that may affect exercise?
Yes
No
If yes, please list your medications
Is there anything else I should know to help make your training safe and effective?
sleep your me
How many days per week can you realistically commit to exercise?
1-2
3-4
5+
How would you rate your current nutrition habits?
Poor
Fair
Good
Excellent
Average stress level
Low
Moderate
High
Average hours of sleep per night
Less than 5
5-6
7-8
8+
What helps motivate you most?
How do you prefer to be coached?
Encouragement & support
Accountability & structure
Challenging/pushed hard
Education & explanations
Combination of all
Anything specific you would like from me as your trainer?
Client Agreement
*
By submitting this form I confirm that the information provided is accurate to the best of my knowledge. I understand that participation in exercise and fitness activities involves some level of physical risk.
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