PERSONAL TRAINING INTAKE SURVEY
Name
*
First Name
Last Name
Email
*
example@example.com
Instagram handle
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
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Health & Medical History
Are you currently taking any medications that could affect your training?
*
If no please state
Do you have any current or past injuries or medical conditions I should be aware of?
*
If no please state
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Fitness Assessment
What is your biological gender?
*
What is your age?
*
What is your height (feet/inch)?
*
What is your current weight (kg)?
*
How active is your current day?
*
Lightly active (4-8k steps)
Active (8-12k steps)
Very active (12k+ steps)
How often do you exercise (30+ mins)
*
Little/no exercise
1-3 times a week
4-6 times a week
Daily / physical job
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Goals & Motivations
What is fitness goals
*
Weight loss
Muscle Gain
Strength improvement
Endurance
Other
Short term goal (3 months)
*
Long term goal (6-12 months)
*
If unsure leave blank
How do you feel about accountability? Would you like regular check-ins or progress updates?
*
What type of training do you prefer (e.g., strength, cardio, flexibility, etc.)?
*
What type of programming would you like?
*
Please Select
Online coaching
1-2-1 Coaching
2-2-1 Coaching (with a friend)
On a scale of 1-10, how committed are you to achieving your fitness goals?
*
Please Select
1
2
3
4
5
6
7
8
9
10
Is there anything else you’d like me to know to help you achieve your goals?
*
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Submit
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