Personal Trainer Client Intake Form

You Were Born To Blossom

New client Application
Name

First NameLast Name
Birth Date

MonthDayYear
I’m interested in training
Height
cm
Weight
kg
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Do you have any diagnosed health problems?
What is your occupation ?
If wanting in person training what is your availability and how many days a week would you like to train with me in a private gym?
What are your fitness goals and expectations of me as your trainer?
How does your current diet look like?
What is your daily activity level?

1

2

3

4

5

1 is None, 5 is High
Which of the following statements fit in with your goals?

Other
Should be Empty:

You Were Born To Blossom