Intake Form

CR-Athletics Intake Form

Upon completing this form you will be contacted via email and given the option to schedule either a 15 minute call, a 30 minute virtual assessment, or a 60 minute in-person assessment
Email*
example@example.com
What are you looking for?*

In-Person Coaching (one-on-one in-person personalized training/coaching)Online Training (Personalized virtual training program)
Name*

First NameLast Name
Picture of yourself (optional) - will only be used for our client management system

Cancelof
Mobile Number*
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth*

MonthDayYear
Date
Age*
Gender*
Height*
Weight*
How did you hear about us?

InstagramCR-Athletics websiteword of mouthReferralOther
(If applicable) What is the name of the individual who referred you to CR-Athletics
Are you currently taking any medications that would stop you from doing sport or exercise?*

YesNo
If you answered "yes" to the question above please list the medications
Do you have any preexisting cardiovascular condition that would stop you from sport or exercise?*

YesNo
If you answered "yes" to the question above please list the condition
List any medical conditions that would impact your response to exercise or that we should be aware of*
List and describe all current or prior injuries, surgeries or areas of nagging discomfort*
List any specific exercises, movements, or general activities that you eliminated or stopped doing due to pain*
List any specific exercises or movements that you simply do Not like to do*
List any specific exercises or movements that you just Love to do*
Do you currently participate in a formal resistance training routine on a consistent basis? If so, at what frequency?*
How many days per week do you currently perform other modes of activity or exercise (run, swim, spin, yoga, etc.)?*

1x / week2x / week3x / week4x / week
List any fitness based events you are preparing for or any competitive sports that you currently play*
Describe the goals that CR-Athletics can help you to work towards*
Are you interested in a certain type of membership?*

Online CoachingIn-person TrainingI am not sure yet and would like to discuss options
Do you have an idea or goal of how many days you would like to train per week?*

2x / week3x / week4x / weekI am not sure and would like guidance and recommendations from CR-Athletics
What type of equipment do you currently have access to?*

DumbbellsKettlebellsBarbellLandmineCable machineCardio equipmentTurfMini-bands (small bands)Long resistance bandsSledTRXPhysio ballJump ropeSlidersChin-Up bar
Please include any additional information about the equipment below
(Online only) Please upload a picture of your training space

Cancelof
If scheduling a virtual assessment, do you prefer FaceTime (phones only) or Zoom?*

I prefer FaceTimeI prefer Zoom
Should be Empty:

CR-Athletics Intake Form