Personal Trainer Client Intake Form

1

Name* This field is required.

First Name

Last Name

2

Gender* This field is required.

Female (ONLINE or IN PERSON HTX)

Male (ONLINE ONLY)

3

Which kind of training are you interested in?* This field is required.

Online

In person training (HTX)

4

Age* This field is required.

5

Height* This field is required.

6

Weight* This field is required.

Ibs

7

Phone Number* This field is required.

Please enter a valid phone number.

8

Email* This field is required.

example@example.com

9

Instagram* This field is required.

10

Do you have any injuries? If yes, please list below.* This field is required.

11

How does your current diet look like?* This field is required.

Low-fat

Low-carb

High-protein

Vegetarian/Vegan

No special diet

14

Which of the following statements fit in with your goals?* This field is required.

Improved health

Increased strength

Weight loss

Weight gain

16

After submitting, our team will reach out to you within 24-48 hours. Thank you.