Personal Trainer Client Intake Form

Personal Trainer Client Intake Form

Arrange a call ☎️

Let’s have a natter & Figure out the next steps
Name

First NameLast Name
Birth Date

MonthDayYear
Gender
Please select the best time for your FREE consultation call
Height
cm
Weight
kg
Email
example@example.com
Phone number
Do you have any diagnosed health problems?
Are you taking any medications? If yes, please list below.
Do you have any injuries? If yes, please list below.
Do you smoke?

What is your daily activity level?

	1	2	3	4	5

1 is None, 5 is High

What is your current goal?

Other

Please rate your readiness to change.

	1	2	3	4	5

1 is Worst, 5 is Best

What is your preferred method of contact?
If social media is preferred please leave profile link below
Please verify that you are human
Should be Empty: