Personal Trainer Client Intake Form

Name*

First NameLast Name

Type of Fitness Are You Requesting?*

WOMEN ONLY: Are You Pregnant?

NoYes

How Serious Are You To Start*

I AM READY50%I Need A Push or Two

Instagram and/or Facebook name?*

Birth Date*

MonthDayYear

Gender*

FemaleMale

Height*

cm

Weight*

lb/kg

Phone Number*

Please enter a valid phone number.

Email*

example@example.com

Occupation

Do you have any diagnosed health problems?*

(If you do not have any diagnosed use "No" as a response)

Are you taking any medications? If yes, please list below.*

Do you have any injuries? If yes, please list below.*

What Are Your Goals?*

How does your current diet look like?*

Do you smoke?*

YesNo

What is your daily activity level?

1 is None, 5 is Active Daily

What is your daily stress level?

1 is Low, 5 is High

What days of the week are you availability to train?*

Training Packages

What are you biggest challenges that are keeping you away from reaching your fitness goals?*

Start Date Request*

Date

NOT REQUIRED: Please Submit/Upload 3 BEFORE photos. Use the examples above. Before pictures are mandatory, it helps both of us guide you through your journey. Any issues please contact via email (royalty757fitness@gmail.com)

I agree, being aware of my own health and physical condition, and having knowledge that my participation in any exercise program may be injurious to my health that I am voluntarily participating in using physical activity with Royalty Fitness 757.
Having such knowledge, I hereby release Royalty Fitness 757, their representatives, agents, and successors from liability for accidental injury or illness, which I may incur as a result of participating in the said physical activity. I hereby assume all risks connected therewith and consent to participate in said/agreed fitness program.
I agree to disclose any physical limitations, disabilities, ailments, or impairments that may affect my ability to participate in Royalty Fitness 757 exercise programs.

*Please sign in agreement to the above liability waiver*

Client Signature- Pictures are required, if you want to send immediately, send some regular pics that shows your body type from your Instagram Or Facebook. There are no refunds for payments made once starting the program.*

Signature*

Signed Date*

Date

Client Inquiry