NEW PLAYER INTAKE

Health & Lifestyle

Rows	Yes	No
Do you smoke?
Have you hadany recent surgeries?
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?

How often do you eat at night?

0

1

2

3

4

5

0 is Never, 5 is Always
How often do you eat breakfast?

0

1

2

3

4

5

0 is Never, 5 is Always
How would you rate your diet?

0

1

2

3

4

5

0 is Poor, 5 is Excellent
How many days per week do you exercise?
How long do you usually exercise for?
Please select the reasons you eat (besides hunger).
Please select the day(s) you’re available.
Please select the time(s) you’re available.
What are some of the goals you hope to improve on during your time with SWERVE?

Other
Release and Acknowledgement
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.

@SWERVETENNISCT has informed me that I am the only responsible party both for any injuries sustained during the program and/or incorrect information. I release and discharge the @SWERVETENNISCT trainers, administration and workers from any disclosure of my personal information in this 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 @SWERVETENNISCT team immediately.
Date

MonthDayYear
Date
Client Signature
Should be Empty:

Release and Acknowledgement