Fitness Client Intake Form

Fitness Client Intake Form
Please answer these questions with as much detail and as honestly as you can!
Client Name*

First NameLast Name
Gender*
Birth Date*

DayMonthYear
Date
Height (cm)*
Weight (Kg)*
Email*
example@example.com
What are the big goals you want to achieve when working together?*
When would you like to achieve this by?
How would you describe your current gym program?
How would you describe your current cardio program?
How would you describe your gym experience?

BeginnerIntermediateExperiencedExpert
Are you gaining/maintaining/losing weight with your current schedule?

GainingMaintainingLosing

Health & Lifestyle

	Yes	No
Do you smoke?
Do you drink alcohol?
Do you take any supplements?
Do you feel any pain while doing sports/exercise?
Do you have any health issues, injuries or physical limitations?

If you answered yes to any of the above can you please specify details:
How often can you exercise per week?*
Please select the reasons you eat (besides hunger).

StressDepressionBoredomHappinessHabitAnnoyanceNo other reason
How many calories do you have daily? If you don't know please note down what you eat on a standard day of eating, add as much information as possible.
Please select the best days you can exercise.

MondayTuesdayWednesdayThursdayFridaySaturdaySunday
Please select the best times you can exercise.

Early MorningsMorningsEarly AfternoonsAfternoonsEvenings
What are your goals for training?*

Muscle DevelopmentFat lossReducing StressIncreasing Drive & MotivationTraining for an event/specific sportsOther
Please upload 2-4 pictures with front/side/rear profiles with minimal clothing*

Cancelof
Any other notes or comments
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.

Vivek has informed me that I am the only responsible party both for all the injuries during the fitness program and incorrect information. I release and discharge Vivek from any disclosure of my personal information in this Fitness Client 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 Vivek immediately.
Date*

MonthDayYear
Date
Client Signature*

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Fitness Client Intake Form

Please answer these questions with as much detail and as honestly as you can!

Release and Acknowledgement