Fitness Client Intake Form

Client Name

First NameLast Name

Height

FeetInches

Current Weight

LbsKg

Birth Date

Date

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Area CodePhone Number

Email

example@example.com

Emergency Contact Name

First NameLast Name

Emergency Contact Phone Number

Area CodePhone Number

Please state if you have current/previous health diseases/issues.

Please state whether you take any medication.

Health & Lifestyle

	Yes	No
Do you smoke?
Have you had any surgery since one year?
Do you drink alcohol?
Are you using any additional vitamin or supplements?
Are you tracking your daily food intake?
Have you done sports professionally before?
Do you feel pain while doing sports/exercise?

At which frequency you eat at night?

	0	1	2	3	4	5

0 is Never, 5 is Always

At which frequency you eat breakfast?

	0	1	2	3	4	5

0 is Never, 5 is Always

What is your rate for your nutrition?

	0	1	2	3	4	5

0 is Poor, 5 is Excellent

How often can you exercise per week?

How many months will you do exercise?

Please select the reasons you eat (besides hunger).

Please select the best days you can exercise.

What are your goals for training?

Front Picture ( Please wear gym clothe or tight to the body)

Browse Files

Profile Picture ( Raise arm to the front)

Browse Files

What motivated you to fill out this form?

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 situations during training. I am informed that my information in this form will be kept confidential.

The fitness center has informed me that I am the only responsible party both for all the injuries during the fitness program and incorrect information. I release and discharge the fitness center trainers, administration and workers from any disclosure of my personal information in this Fitness Client Intake Form.

If any of my health, lifestyle or personal information/situation that may prevent my training is changed, I guarantee that I will inform the fitness center authorities immediately.

Payment Policy

As a valued participant in our monthly fitness program, your commitment is essential to achieving the success you desire. Please note that by enrolling in this program, you agree to the following payment terms:

Monthly Commitment: Your enrollment in the program is based on a monthly recurring payment plan. This fee is due regardless of your participation or usage of the program during the month.

Cancellation Policy: If you choose to discontinue the program, you must notify us at least 5 days prior to the start of the next billing period. Failure to provide this notice will result in your obligation to pay for the upcoming month, even if you do not intend to use the program.

Non-Participation: Should you miss sessions or fail to commit to the program within the billing period, you will still be responsible for your monthly payment. Refunds or credits will not be issued for non-participation.

Late Payment Fee: Payments are due on the scheduled billing date each month. If payment is not received within 5 days of the due date, a late fee of $5 will be applied to your account.

By adhering to these guidelines, we ensure a fair and consistent process for all clients. Your commitment is key to your progress and success, and we are here to support you every step of the way.

Date

Client Signature

$120 Monthly Plan Includes: Personalized Training / Suggested Groceries List / Cardio Regimen / App to track progress /Daily Macros / Weekly check-in /Coaching

This Form is not a guarantee of Customer Selection. All forms will be studied in detail and you will be contacted back if you have been selected. The process can take up to 5 business days.

Release and Acknowledgement