Personal Training Client Intake Form

Full Name

First NameLast Name

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Email

example@example.com

MaleFemale

Date of Birth

MonthDayYear

Age

years

Height

cm

Weight

KG

What do you do for a living?

None (seated only)Moderate (light activity such as walking)High (heavy labor, very active)

Do you follow a regular working schedule, do you work days, afternoon or nights?

RarelyA few times a yearA few times a monthWeekly

Please list the physical activities that you participate in outside of the gym and outside of work

If you have any diagnosed health problems list the condition(s).

If you are on any medications, please list them.

What additional therapies are being undertaken for the given health problem(s)?

If you have any injuries, please list them.

What additional therapies are being undertaken for the given injury?

YesNo

Please list:

YesNo

What is your goal with your training? Why?

How often are you willing to train a week to reach your goal?

YesNo

What type of training did you do?

How often do you want to do Personal Training a week?

Please Choose

What are your expectations on me as your Personal Trainer?

1.) CANCELLATIONS

Cancellations should be made at least 24 hours in advance of a scheduled session. Sessions cancelled less than 24 hours in advance will be charged in full to the client.

2.) LATE ARRIVALS

Each session shall be 1 hour in length. Sessions will not be extended (unless time is available) due to the lateness of the client or due to interruptions caused by the client.

3.) ALL THE INFORMATION I HAVE GIVEN IS CORRECT

All the information on this form is correct and to the best of my knowledge. I have sought and followed any necessary medical advice. I understand that all the information given will be kept confidential.

4.) MEDICAL WAIVER AND LIABILITY RELEASE:

I acknowledge that participation in any fitness training, exercise program, or wellness service with Built Not Born Athletics involves inherent risks, including but not limited to injury, illness, or other health complications. I certify that I am physically capable of participating and assume full responsibility for any risks involved. By agreeing below, I release Built Not Born Athletics, its trainers, and affiliates from any liability for injuries, damages, or losses incurred before, during, or after participation.

YesNo

Personal Training Consultation Questionnaire

Part 1. Basic information

Part 2. Lifestyle Information

Part 3. Medical and Health Information

Part 4. Goals

Please Read The Following Terms and Conditions