TrueForm Intake Assessment

  • Wellness Intake Form

  • Personal Information

  • Format: (000) 000-0000.
  • Birthdate*
     - -

  • Emergency Contact

  • Format: (000) 000-0000.

  • Part 1: PreScreening Health Assessment

    Please answer yes or no to the following 7 questions.
  • Has your doctor ever said that you have a heart condition and/or that you should only perform physical activity recommended by a doctor?*
  • Do you feel pain in your chest when you perform physical activity?*
  • In the past month, have you had chest pain when you were not performing any physical activity?*
  • Do you lose your balance because of dizziness, or do you ever lose consciousness?*
  • Do you have a bone or joint problem that could be made worse by a change in your physical activity?*
  • Is your doctor currently prescribing any medication for your blood pressure or for a heart condition?*
  • Do you know of any other reason why you should not engage in physical activity?*

  • If you have answered YES to one or more of the above questions, consult your physician before continuing with this form and before engaging in physical activity. Tell your physician which questions you answered YES to. After medical evaluation, seek advice from your physician on what type of activity is suitable for your current condition. A physical activity medical clearance form is required prior to engaging in training services by TrueForm LLC. Please contact if form is needed.

    If you have answered NO to all of the above questions, please continue with this form.

  • Are you taking any medications and/or supplements?*
  • Do you have any allergies or sensitivities to products and/or foods?*
  • Have you had any injuries resulting in rehab and/or surgery?*
  • Do you have any additional health concerns we should know about?*

  • Photo/Video Consent

  • This authorization grants permission to use your image (still or moving) and/or your spoken words in perpetuity for educational purposes.

    By signing this document, you agree:

    1. To allow the recording of your image and voice (e.g., photographs, audio, or video).

    2. To distribute your image or recording in any medium, be it print or electronic form, which may include the Internet.

    3. To grant permission to other entities to reproduce the images or recording for educational purposes.

    4. That there is no reimbursement for the right to take, or use your photograph or video or recording.

  • Do you give TrueForm Nutrition & Fitness consent to use your video and/or photos?*

  • Before Training Questionnaire

  • What type of plan have you tried in the past to reach your wellness goals?*
  • Have you ever tried a specific diet approach now or in the past?*
  • Are you comfortable with measuring tools? (e.g., Scales, Measuring Tapes, Performance Test, etc.)*
  • What area(s) are you looking to improve on?*
  • Do you stretch?*
  • What is your current fitness level?*
  • Are you ready to gain the tools to look, feel, & find your TrueForm?

  • 1. Billing agreement: All personal training clients are billed on a pre-pay basis. Bills are issued directly to a client and are due upon receipt before training begins.
    2. Length of sessions and appointment times: Each training session is based on a [60 minute] workout, unless appointed otherwise. To get the most out of our efforts, please be ready to exercise at the appointed time. If you are more than 15 minutes late for a scheduled session, it will be considered a no-show and you will be charged normal session price.
    3. Online Coaching: Each Strategy Chat/Virtual Session is based on a [30 minute] time frame. To get the most out of our efforts, please be ready to meet at the appointed time. If you are more than 15 minutes late for a scheduled session, it will be considered a no-show and you will be charged normal session price.
    4. Cancellation policy: All sessions are arranged on a scheduled appointment basis. For the most effective use of time, all clients are asked to give 24-hour notice when cancelling an appointment. This means a cancellation should be made at least 24 hours before the scheduled appointment by calling or texting TrueForm directly. Personal training, semi private, and online coaching sessions cancelled inside of 24 hours of the scheduled appointment will be billed at the normal rate of a single session and deducted from your account unless a make-up session is completed within 24 hours of scheduled session. A $20 fee will be charged to your account if cancelation/reschedule occurs within 1 hour of scheduled session. If arriving late for a session, the scheduled time frame will remain the same and at the scheduled rate.
    5. Expiration of sessions: You are aware that all packages are on a 4 week commitment, unless stated and agreed upon otherwise. If you fail to complete the scheduled sessions within allowed and agreed upon timeframe, you understand your training sessions will expire and that you are responsible to pay any remaining balance on your account.
    6. Release of results upon program completion: Client photos and testimonials are requested upon completion of the first week and initial program completion of the last week.
    7. Use of nutritional supplements: To guarantee safety, we request that all clients do not use any potentially dangerous stimulants like “diet” or “fat burning” pills of any kind.

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