Personal Training Intake Form
Thank you for inquiring about personal training at VIBE FITNESS! Please fill out the below intake form and a trainer will be in touch to schedule your free consultation. If you have a specific question, you can email your club at LIC@VibeFitness.com, PT-BQE@VibeFitness.com or GP@VibeFitness.com
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
What languages do you speak?
*
ENGLISH
SPANISH
Burmese(Myanmar)
Portugese
Other
What location is your membership with?
*
Please Select
LIC
Greenpoint
BQE
Appointment Type:
*
Please Select
Free InBody Scan Only
Free InBody + 30 Min Workout
Height
Weight
Gender
Male
Female
Other
Training Goals (Check all that apply)
*
I want to lose weight
I want to gain muscle
I want to tone
Athletic Conditioning
Bodybuilding
Competition Preparation
I plateaued my weight loss
Mobility Improvement
Nutritional Guidance
Please select the days/times that work best to meet with an available trainer? Kindly note that your appointment is not confirmed until someone from the PT department contacts you to confirm their availability
*
Rows
6am-8am
8am-10am
10am-12pm
12pm-4pm
4pm-6pm
6pm-8pm
8pm-10pm
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Please select the days/times that work best to meet with an available trainer? Kindly note that your appointment is not confirmed until someone from the PT department contacts you to confirm their availability
*
Rows
6am-8am
8am-10am
10am-12pm
12pm-4pm
4pm-6pm
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Please enter the date and time you're available for your consultation (Inbody Scan + Free Session). Kindly note that your appointment is not confirmed until someone from the PT department contacts you to confirm their availability
*
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Are you considering personal training as part of your fitness plan?
*
Yes — I’m ready to get started
Maybe — I’m exploring options/I’d like more information
Not at this time
Are you interested in working with a specific trainer? If so, select their name below
Please Select
Fernanda R. (BQE)
DeAngelo P. (BQE/GP)
Jaeem E. (BQE)
Marcus G. (BQE)
Erwin D. (BQE)
Katie F. (BQE)
Davon S. (BQE)
Myo Htut N (BQE)
David B. (GP)
Kyle C. (GP)
Natalie (GP)
Manu L. (GP)
Journie C. (GP/LIC)
Jordan R. (GP)
Jared N. (GP)
Alyx S. (GP)
Christian Manuel P. (GP)
Corey Terell Jr. (GP)
John Nguyen (LIC)
Patricia Urtubia (LIC)
Sabastian Mora(LIC)
Andrii Olinchuk (LIC)
Christopher Hutchinson(LIC)
Anthony Parker (LIC)
Consultation Participation Agreement: The Vibe Fitness assessment is a measure of your overall fitness level. It is not intended as a formal stress test. Explanation of the Fitness Evaluation: The Vibe Fitness Assessment incudes measures of weight, percentage of body fat, resting heart rate, blood pressure, flexibility, muscle strength and muscle endurance. You will also be performing the following: a functional movement screen (FMS), and a series of exercises to test for strength and endurance. We may stop any test at any time because of signs of fatigue or discomfort. During the performance of the test a personal trainer will monitor your heart rate. Risks and Discomforts: There exists the possibility of certain changes during the Vibe Fitness assessment. These include abnormal blood pressure, fainting, disorders of the heart beat and in very rare instances, heart attack. Every effort will be made to minimize these discomforts by a preliminary screening and by observation during testing. Benefits to be expected: The information obtained during this test will help you gauge your fitness level and will be used to develop effective, goal-directed fitness programs. Inquiries If you have any concerns or questions, please ask us for further explanations. Freedom of Consent: Your permission to perform the Vibe Fitness assessment is voluntary. You are free to deny consent or participation if you so desire.
*
I Agree
Medical Questionnaire
Please complete the below so your trainer can have knowledge of any medical conditions. If you answer "Yes" to any of these questions, we recommend that you see a doctor before you begin your exercise program
Select your current medical conditions or perscriptions
*
a heart condition and in which you should only do physical activity recommended by a doctor
currently prescribed drugs (for example water pills) for a blood pressure or heart condition
Are you over 65 and not accustomed to consistent exercise
Are you diabetic
none of the above
Other
Do you experience any of the below during exercise?
*
pain in your chest when you do physical activity
irregular or racing heart rate during rest or exercise
lose your balance because of dizziness or do you ever lose consciousness
bone or joint problem that could be made worse by a change in your physical activity
none of the above
Do you know of any other medical reasons you may have causing prevention of physical activity?
*
Yes
No
If you have any medical conditions, muscle or joint paint, not mentioned above or would like to detail a condition prior to training, please provide more information below:
Submit
Should be Empty: