Client Intake Form

1
Name* This field is required.
First Name
Last Name
2
Pronouns* This field is required.
3
Email* This field is required.
example@example.com
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Phone Number* This field is required.
Area Code
Phone Number
5
Birthday* This field is required.
Date
Year
Month
Day
6
Current Occupation* This field is required.
7
Do you have any chronic illnesses or medical conditions? If yes, please explain with respect to how it might limit or affect your strength training practice.* This field is required.
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8
Do you currently exercise? Please describe your exercise history, going as far back as you feel is relevant.* This field is required.
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9
What are your short-term (1-2 month) goals? * This field is required.Be as specific as possible. These goals can be related to strength, general fitness, physical attributes, self esteem, pain management, gender affirmation, etc.
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What are your long-term (4-6 month) goals? Be as specific as possible.* This field is required.Be as specific as possible. These goals can be related to strength, general fitness, physical attributes, self esteem, pain management, gender affirmation, etc.
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What are some of the barriers preventing you from reaching these goals?* This field is required.Ex. time or schedule constraints, lack of direction/guidance, cost constraints, habit formation, etc.
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Which kind(s) of coaching are you interested in?* This field is required.
Private Strength Training (1:1)
Small Group Strength Training
Programming Only
Remote Coaching (Programming + Technique Review)
Strongman Classes or Coaching
13
Do you have a monthly budget for strength coaching? It can be a range.* This field is required.Based on your goals, interest, and budget, I will put together a recommended coaching package specifically for you.
14
Anything else you would like for me to know?
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