Personal Trainer Client Intake Form

1

Name* This field is required.

First Name

Last Name

2

Date of Birth* This field is required.

3

Phone Number* This field is required.Please confirm your phone number is correct before submitting

Please enter a valid phone number.

4

Email

example@example.com

5

Do you have any injuries? If yes, please list below.[ previous and/or current ]

6

How active are you currently?* This field is required.

Sedentary (minimum exercise 0-2 times per week)

Moderate (exercise 3-4 times/week)

Very Active (exercise 5-7 times/week )

7

What style of training are you seeking?* This field is required.

In Person (Houston Only)

Virtual

Hybrid (Houston Only)

8

What time of day do you prefer to train* This field is required.

Morning

Afternoon

9

Which days are you available to train?* This field is required.It’s not about having time, it’s about making time.

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

10

What is your WHY?* This field is required.

Build Strength

Lose Weight

Injury Recovery / Corrective Exercise

Improve Performance