Lindsey Welgush Personal Training & Coaching
Client Intake Questionnaire -- Please note that all information provided in this document is 100% confidential. I'm excited to work with you. :)
Name
First Name
Last Name
Email
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Date of Birth
What is your occupation? (this helps give me an idea of your level of activity outside of planned training)
What service option interests you?
In-Person Personal Training
Online Coaching
Powerlifting Coaching
How do you describe your fitness experience? (beginner, intermediate, advanced, etc.)
How many days a week would you like to train?
What does your current intentional physical activity look like?
Do you have any physical limitations that might inhibit your ability to train?
What new skills would you like to learn?
What are your short-term (1-6 months) and long-term (12+ months) goals?
What is your current stress level on a scale of 1-5? (0 being zero stress and 5 being extreme stress/very difficult to function day-to-day):
What does your average daily nutrition intake look like? (let's go with yesterday)
Is there any other information that you think is important to share?
Submit
Should be Empty: