Personal Trainer Client Intake Form

Getting to Know You

NEW CLIENT INFORMATION
Name

First NameLast Name
Birth Date

MonthDayYear
Pronouns
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Give me a callShoot me a textSend me an email
Training at my home with Pilates propsTraining at my office with Pilates propsTraining on traditional Pilates equipment at your studio
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
If I will be traveling to you, please include any gate code or neighborhood entry information
Do you have a dedicated area in your home/office to train? Please describe the space.
Do you have pets? If so, please list.
Emergency Contact

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Relationship
Absolute BeginnerSome ExperienceEstablished PracticeAdvanced Practice
1/week2/week3/week4+/week

Please check days & time you prefer to train:

Improved healthImproved enduranceIncreased strengthIncreased muscle massFat lossInjury recovery & rehabilitationOther
Do you have any diagnosed health problems or current medical conditions?
Do you have any chronic injuries? Please include any past surgeries and/or pregnancies.
What other types of exercise are you currently participating in?
What is your daily activity level?

1

2

3

4

5

1 is None, 5 is High
What is your daily stress level?

1

2

3

4

5

1 is Low, 5 is High
Please rate your overall readiness to change/invest in your health

1

2

3

4

5

1 is Not Very, 5 is Ready to Roll!
Anything else I should know about your general health, wellness, or workout preferences?
Should be Empty:

Getting to Know You