Personal Training Intake Form
Contact Information
If you are a current client or a potential client, please fill out your information below so that you can be reached in the best way that you choose.
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
Goals & Lifestyle
Please answer the following questions to help get you started on your health journey.
What are your primary fitness goals that you want to reach?
Please include current goals you are working on and new goals in this response.
If one of your goals is to lose/gain weight, how much weight would you like to gain or lose?
What has caused you currently or in the past to not be able to reach your fitness & health goals?
If you have exercised in the past, describe how you felt afterwards. If you have never exercised, describe how you would like to feel with adding exercise into your lifestyle.
Which specific areas of your body would you like to focus on?
Have you been on any type of plan on your own currently to try and achieve what you are wanting to focus on? If so, describe
On a scale of 1-10 (1= very low & 10= very high) how committed are you to making these changes starting today?
How long have you been THINKING about making a commitment to achieving your goals?
Outside of myself, who will be supporting you during this lifestyle change?
How many days a week are you willing to commit towards your program? This will help me design a customized program around your schedule.
Why are you interested in having an experienced personal trainer work alongside you to help you reach your health goals?
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