I'm so excited to have you Train with Me!

I'm so excited to have you Train with Me!
Name

First NameLast Name
Birth Date

MonthDayYear
Date
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Emergency Contact Name

First NameLast Name
Emergency Contact Phone Number

Area CodePhone Number
What is your profession?
How would you rate your work life balance?
What are your main goals of working with me?
Do you have any health concerns, or ailments I should know about?
Are you currently taking any medication?
What is your least favorite type of exercise?
What is your favorite type of excercise?
How would you rate your current stress level?
How many hours of sleep do you get at night on average? And how would you rate your quality of sleep?
What do you feel is your biggest obstacle when it comes to health and fitness?
What is the best day and time for a weekly checkin? I try and do these on Monday and Tuesday, Wednesday afternoon and Thursday Morning!
What does your built community/family look like? Partner, Spouse, Kids, Ages, & Support system?

Health & Lifestyle

Rows	Yes	No
Do you smoke?
Have you had any recent surgeries?
Do you drink alcohol?
Are you using any additional vitamin or supplements?
Are you tracking your daily food intake?
Do you know what Macros are?
Do you feel pain while doing sports/exercise?

Are you a late night snacker?

	0	1	2	3	4	5

0 is Never, 5 is Always

How often do you eat breakfast?

	0	1	2	3	4	5

0 is Never, 5 is Always

How would you rate your current nutrition understanding?

	0	1	2	3	4	5

0 is Poor, 5 is Excellent

Please select the best days you can exercise.
What time of day do you like to workout?
What type of fitness equipment do you currently have access to?
Release and Acknowledgement
I, {clientName}, hereby acknowledge that the information I've given above is complete and accurate. I understand all the risks and I accept all the responsibility for any undesired situations during training. I am informed that my information in this form will be kept confidential. HillaryLynnFitness has informed me that I am the only responsible party both for all the injuries during the fitness program and incorrect information. I release and discharge the fitness center trainer, administration and workers from any disclosure of my personal information in this Fitness Client Intake Form. If any of my health, lifestyle or personal information/situation that may prevent my training is changed, I guarantee that I will inform Hillarylynnfitness immediately.
Date

MonthDayYear
Date
Client Signature
Should be Empty:

Release and Acknowledgement