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
If you need to get in touch, I prefer you:
I am interested in:
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
Which best describes your Pilates Experience
How often would you like to practice Pilates each week?

Please check days & time you prefer to train:

Which of the following statements fit in with your fitness goals?

Other
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