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
FemaleMale
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.*
YesNo

What is your daily activity level?

	1	2	3	4	5

1 is None, 5 is High

Improved healthImproved enduranceIncreased strengthIncreased muscle massFat lossOther

Please rate your readiness to change.

	1	2	3	4	5

1 is Worst, 5 is Best

TelephoneEmailWhatsApp messengerSocial media messaging
If social media is preferred please leave profile link below *
Please verify that you are human*
Should be Empty: