XenoFit Client Intake Form

XenoFit Client Intake Form
Client Name

First NameLast Name
Birth Date

MonthDayYear
Date
Email
example@example.com
Phone Number

Area CodePhone Number
Height:
Weight:
Are you battling any injuries, physical or mental health problems?
Do you take any prescription medications you feel may interfere with training goals?
Do you use recreational drugs, drink alcohol regularly, or smoke?
Years/months exercising at least x3 a week:
Do you have access to a fully equipped gym?
What are your 1, 5, and 10 year fitness goals:
What is your current fitness priority (pick 1):

Absolute strengthMaximum hypertropyOptimum fat lossCardiovascular conditioningImprove specific health markersUnsureOther
Have you competed in any fitness events? 5k Run, Powerlifting Meet, Tough Mudder, etc
What do you hope to achieve by using XenoFit as your fitness coach / trainer?
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 outcomes during training. I am informed that my information in this form will be kept confidential. Xenofit, LLC has informed me that I am the only responsible party both for all the injuries that occur during training program and from supplying incorrect information. If any of my health, lifestyle or personal information/situation that may prevent my training is changed, I guarantee that I will inform XenoFit trainers immediately.
Date

MonthDayYear
Date
Client Signature

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XenoFit Client Intake Form

Release and Acknowledgement