Syxx Performance Client Intake Form

About me — Jordan | Syxx Performance

I hold an Honours Bachelor of Applied Science in Kinesiology and a Diploma in Fitness and Health Promotion. With years of hands-on experience as a fitness trainer, stretch practitioner, and rehab assistant, I specialize in helping people move better, feel stronger, and build long-term confidence in their bodies.&#13;&#10;&#13;&#10;At Syxx Performance, I offer mobile assisted stretching that targets key areas like the lower back, shoulders, hips, neck, hamstrings, and more — using guided techniques that support your flexibility, release built-up tension, and help restore functional movement.&#13;&#10;&#13;&#10;I don’t just coach — I train with you. Every session is tailored to your body, your pace, and your needs. Syxx Performance is more than just fitness; it’s a movement — one rooted in growth, support, and long-term change.&#13;&#10;&#13;&#10;💬 Ready to feel the difference?&#13;&#10;Fill out the info sheet so we can connect directly and build a plan that fits you.&#13;&#10;&#13;&#10;📍Serving the GTA | Mobile Service&#13;&#10;📩 Please allow up to 48 hours for a response.

Name

First NameLast Name

Birth Date

MonthDayYear

Gender

Height

Ft, in

Weight

Lbs

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Email

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Preferred method of communication

Do you have any diagnosed health problems?

Are you taking any medications? If yes, please list below.

Do you have any injuries or Anatomical irregularities? If yes, please list below. (Scoliosis, Plantar Fasciitis, Anything happened in the past 5 years)

Do you have any general pain/tension? If so where?

How does your current diet look like?

Do you smoke?

What is your daily activity level?

1 is None, 5 is High

What is your daily stress level?

1 is Low, 5 is High

Are you more interested in Assisted Stretching or Fitness training

Do you have access to a gym or weights at home?

Other

What is your preferred training format

How often do you want to do Fitness training/ Assisted Stretching a week?

Which of the following statements fit in with your goals?

Were you referred by anyone? if so by who

Please rate your readiness to change.

1 is Worst, 5 is Best

I understand that the services provided by Syxx Performance are for general fitness, mobility, and flexibility enhancement. I acknowledge that these services do not constitute treatment for medical conditions or injuries. I consent to receive guided movement and assisted stretching as part of a performance-based wellness plan. By signing below, I confirm that I am the individual named in this form, and I am providing my own informed consent to receive these services.

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