Personal Training Intake Form

Personal Training Intake Form

Thank you for inquiring about personal training at BQE 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 BQE@VibeFitness.com or GP@VibeFitness.com
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
What location is your membership with? *
Are you interested in*
Height
Weight
Gender

MaleFemaleOther
Training Goals (Check all that apply)*

I want to lose weightI want to gain muscleI want to toneAthletic ConditioningBodybuildingCompetition PreparationI plateaued my weight lossMobility ImprovementNutritional Guidance

Please select the days/times that work best to meet with an available trainer?*

	6am-8am	8am-10am	10am-12pm	12pm-4pm	4pm-6pm	6pm-8pm	8pm-10pm
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*

MonthDayYear
Date
Hour MinutesAM/PM Option
Are you interested in working with a specific trainer? If so, select their name below
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 doctorcurrently prescribed drugs (for example water pills) for a blood pressure or heart conditionAre you over 65 and not accustomed to consistent exerciseAre you diabeticnone of the aboveOther
Do you experience any of the below breathing, dizziness or joint complications during exercise*

pain in your chest when you do physical activityirregular or racing heart rate during rest or exerciselose your balance because of dizziness or do you ever lose consciousnessbone or joint problem that could be made worse by a change in your physical activitytion 4none of the above
Do you know of any other medical reasons you may have causing prevention of physical activity?*

YesNo
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:
Should be Empty:

Personal Training Intake Form

Medical Questionnaire