Personal Trainer Client Intake Form

1

Name* This field is required.

First Name

Last Name

2

Age* This field is required.

yrs

3

Gender* This field is required.

Female

Male

4

Height

ft' in"

5

Weight

LBS

6

Instagram Username

if applicable

7

How often, if any, are you currently training per week and what kind of training is this?

8

Do you have any current or previous injuries that affect your training?

9

What kind of gym or equipment do you have access to?

11

In detail describe your fitness goals.

12

What steps, if any, are you currently taking to achieve this goal?

13

Please rate your readiness to commit to your fitness goals

14

Why are these goals important to you?

15

What is keeping you from achieving your goal?

Poor Nutrition

Unorganized Training

Lack of Accountability/Motivation

Lack of Structure/Knowledge

All the Above

16

Describe your current diet

17

Do you Track Macros?

Yes

No, But I'm willing to learn

No, and I don't want to learn

18

Phone Number

Please enter a valid phone number.

19

Email* This field is required.

example@example.com

20

What are you looking to get out of this coaching experience?

21

How are you approaching this commitment?

I have less than $100 to spend, I just want something basic

My budget is tight, but if the program guarantees results I'm committed

I'm willing to do whatever I need to accomplish my fitness goals