New Client Health & Fitness Assessment

New Client Health & Fitness Assessment

This questionnaire helps me design a safe, effective program tailored specifically to your goals and history. Please complete all sections honestly. This information is confidential and essential for your safety and success.
Full Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Date of Birth*

MonthDayYear
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact*

First NameLast Name
Emergency Contact Number*
Please enter a valid phone number.Format: (000) 000-0000.
Have you had any significant injuries, surgeries, or chronic conditions in the past 2 years? If yes, please add them here:
YesNo
If yes, please specify:
YesNo
If yes, please list:
YesNo
If yes, please describe:
YesNo
Lower backMid backUpper back/neck areaShoulder(s)Hip(s)Knee(s)Ankle(s)Other
I have low to a normal amount of stressYesAlways
5 or less6-78-9
Low to moderate (computer/phone work during the day, little exercise)Moderate (light cardio, walking, some resistance training)Active (resistance training and cardio endurance training 3 or more times a week)
0 days/week1-2 days/week3-4 days/week5-7 days/week
Favorite music to workout to?*
How do you spend most of your time during the week?*
What does your ideal wellness routine look like if you had zero constraints?*
WeeklyMonthlyQuarterly1-3x/year
Other fitness/wellness memberships and professional services regularly utilized:
i.e. Peloton, massages, sauna, physical therapy, Pilates, chiropractor, etc.
Lose body fatBuild muscleImprove strengthImprove cardioGeneral fitness and healthPost-injury fitness
Lose body fatBuild muscleImprove strengthImprove cardioGeneral fitness and healthPost-injury fitness
What are your fitness goals in your own words? *
Please be as specific as you can, no judgement, all information is helpful
What are your biggest roadblocks to achieving your goals, if you have any?
Please be as specific as you can, no judgement, all information is helpful
3-6 months6–12 monthsNo rush, I'm making it a lifestyle
1 (not ready yet)2345 (ready to go!)
YesNo
If yes, what did you enjoy most about having a trainer?
Morning (5am-10am)Mid-morning (10am-12pm)Afternoon (12pm-4pm)Evening (4pm-7pm)
In-Person Gym (Kirkwood, Atlanta)In-HomeFully Remote Client
How many day a week do you want to train (including together and on your own)?
Method of personal training:
If you were referred by someone, list them here:*
Policies
1.) CANCELLATIONS Cancellations should be made at least 12 hours in advance of a private scheduled session. Sessions cancelled < 12 hours in advance may be charged in full to the client. Please communicate if a conflict arises and accommodations can be made.

2.) LATE ARRIVALS Sessions will not be extended due to the lateness of a client or due to interruptions caused by the client. You are entitled to the entirety of the session. If you communicate about needing a late start, you are welcome to a late start and session will be remainder of your booked time.

3.) SESSION PRICING I will pay the agreed upon pricing before the first scheduled session of my pack, group class, semi-private, or in-app program.

4.) Packages and all purchases are non-refundable and expire within 6 months of purchase date.

5.) All of 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.
YesNo
Should be Empty:

New Client Health & Fitness Assessment

Policies