Ready to get started? Complete the brief health and fitness intake form below to schedule your FREE 30-minute fitness consultation. Name * First Name Last Name Phone (###) ### #### Email * What kind of training are you interested in? * Online (General Plan) Online (Personalized Plan) In-Person Training Small Group Training (3 ppl max) Gender * Male Female Birthday * MM DD YYYY Weight * Height * Part 2 > Lifestyle Information What do you do for a living? * What is the level of activity at your job? * None (seated only) Moderate (light activity) High (heavy labor, very active) How often do you travel? * Rarely A few times a year A few times a month Weekly Part 3 > Medical & Health Information Please list any physical activities you do outside of work: Do you have any diagnosed medical conditions? * Are on any medications? Please list them Are you experiencing any stress or motivational problems? * Often Occasionally Rarely Never Do you smoke cigarettes or vape? * Daily Occasionally Rarely Never How would you characterize your current diet? * Low Fat High Protein Low Carb Vegetarian / Vegan GLP-1 No Special Diet Part 4 > Goals Survey I'm ready to make a lifestyle change Strongly Disagree Disagree Neutral Agree Strongly Agree Which of the following best describe your current goals? * Improved Health Improved Endurance Increased Strength Increased Muscle Mass Fat Loss Better Overall Quality of Life What is your goal with training? Why start now? * What is your timeline for achieving your goals? * Within the next 2 months Within the next 3 months Within the next 6 months Within the next 12 months How often are you willing to train per week to achieve your goals? * Are you currently exercising regularly (3x per week or more)? * Yes No Have you trained with a personal trainer before? * Yes No At what times in the day would you prefer to train? * Morning Mid-Day Afternoon Evening Other How often do you want to do personal training per week? * 1 Session 2 Sessions 3 Sessions 4 Session 5 Sessions What are your expectations for me as your personal trainer? CANCELLATIONS Cancellations should be made at least 24 hours in advance of a scheduled session. Sessions cancelled less than 24 hours in advance will be charged in full to the client. LATE ARRIVALS Each session shall be 1 hour in length. Sessions will not be extended (unless time is available) due to the lateness of the client or due to interruptions caused by the client. ALL THE INFORMATION I HAVE GIVEN IS CORRECT All the information on this form is correct and to the best of my knowledge. I have sought and followed any necessary medical advice. I understand that all the information given will be kept confidential. I AGREE TO THE ABOVE TERMS & CONDITIONS * Yes No Thank you!
