PT Intake Form

Personal Training Intake Form

Thank you for inquiring about personal training at BQE Fitness! Please fill out the below intake form and a trainer will be in touch to schedule your free consultation. If you have a specific question, you can email pt@bqefit.com
Full Name*

First NameLast Name
Member ID
Instagram (for Sweepstakes)
Phone Number
E-mail*
example@example.com
Height*
Weight*
Sex

MaleFemaleOther
Training Goals*

I want to lose weightI want to gain muscleI want to toneAthletic ConditioningCompetition PreparationI've plateaued with my weight lossIncrease MobilityNutritional GuidanceOther

Please select the days/times you workout at BQE Fitness and when you're available to meet with a trainer*

	6AM 8AM	8AM-10AM	10AM-12PM	12PM-2PM	2PM-4PM	4PM-6PM	6PM-8PM	8PM-10PM
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
SATURDAY
SUNDAY

Please enter the date and time you're available for your consultation. Kindly note that your appointment is not confirmed until someone from the PT department contacts you to confirm their availability *
Are you interested in working with a specific trainer?
Please complete the medical questionnaire before your appointment Link: https://forms.gle/67BLH1CcgNYV7F5WA*

I have completed the medical questionnaireI will complete the medical questionnaire before I meet with a trainer
Consultation Participation Agreement: The BQEFIT assessment is a measure of your overall fitness level. It is not intended as a formal stress test. Explanation of the Fitness Evaluation: The BQEFIT Assessment incudes measures of weight, percentage of body fat, resting heart rate, blood pressure, flexibility, muscle strength and muscle endurance. You will also be performing the following: a functional movement screen (FMS), and a series of exercises to test for strength and endurance. We may stop any test at any time because of signs of fatigue or discomfort. During the performance of the test a personal trainer will monitor your heart rate. Risks and Discomforts: There exists the possibility of certain changes during the BQEFIT assessment. These include abnormal blood pressure, fainting, disorders of the heart beat and in very rare instances, heart attack. Every effort will be made to minimize these discomforts by a preliminary screening and by observation during testing. Benefits to be expected: The information obtained during this test will help you gauge your fitness level and will be used to develop effective, goal-directed fitness programs. Inquiries If you have any concerns or questions, please ask us for further explanations. Freedom of Consent: Your permission to perform the BQEFIT assessment is voluntary. You are free to deny consent or participation if you so desire.

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Personal Training Intake Form