STRYDE Fitness Intake Form

Consultation Questionnaire
Client Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth

MonthDayYear
Date
Age
Years
Height
CM/Feet
Weight
LBS
Phone Number
Format: (000) 000-0000.
Email
example@example.com
Emergency Contact Name

First NameLast Name
Emergency Contact Phone Number
Format: (000) 000-0000.
Medical and Health Information
Please List if You Have Current/Previous Chronic Conditions.
Diabetes, Asthma, High/Low Blood Pressure, etc.
Please List Whether You Take Any Medication.
Please List Major Surgeries Or injuries Past/present.
Health And Lifestyle

Rows	Yes	No
Do you smoke?
Do you drink alcohol?
Are you using any additional vitamin or supplements?
Are you tracking your daily food intake?
Have you done any sports before?
Do you feel pain while doing sports/exercise?

Please List Any Physical Activities That You Participate In Outside Of Work Or The Gym.
Have You Worked Out With A Trainer In The Past? What Were The Pros/Cons Of Your Experience?
How often do you eat dinner?

0

1

2

3

4

5

0 is Never, 5 is Always
How often do you eat breakfast?

0

1

2

3

4

5

0 is Never, 5 is Always
How would you rate your nutrition?

0

1

2

3

4

5

0 is Poor, 5 is Excellent
How often can you exercise per week?
How many months will you do exercise?
Select preferred training days
What Does Success With A Personal Trainer Look Like For You? Please Elaborate In Detail,This Is A Critical Question.
What Type of Training Are You Interested In?
Type a question
Please select the best times you can exercise.
What are your goals for training?

Other
Terms And Conditions
Waiver
- Must Be Signed And Completed Before Personal Training Begins.
Video Call Cancellations
- Cancellations Should Be Made At A Minimum Of 24 Hours In Advance Of A Scheduled Call. Each Call Could Be Up To 30 Minutes In Time.
Coach/Client Contact Interaction
- I Will Be Available To Reply To All Emails, Calls, Or Text Within 48 Hours, But Ususally 24 Hours Unless Otherwise Sated.
- I Will Not Check In With You Outside Our Agreed Times, However. I Welcome You to Contact Me Around Any Training And Nutrition-Related Questions. It Is Up To You To Ask The Questions To Get The Most Out Of Your Service.
I hereby acknowledge that the information I've given above is complete and accurate. I understand all the risks and I accept all the responsibility for any undesired situations during training. I am informed that my information in this form will be kept confidential.
Date

MonthDayYear
Date
Client Signature
Should be Empty:

Consultation Questionnaire

Medical and Health Information

Health And Lifestyle

What Type of Training Are You Interested In?

Terms And Conditions