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.

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.

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.

💬 Ready to feel the difference?
Fill out the info sheet so we can connect directly and build a plan that fits you.

📍Serving the GTA | Mobile Service
📩 Please allow up to 48 hours for a response.
Your Information
Name*

First NameLast Name
Birth Date*

MonthDayYear
FemaleMale
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
Phone callEmailText messages
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?*
Low-fatLow-carbHigh-proteinVegetarian/VeganNo special diet
YesNo
What is your daily activity level?*

1

2

3

4

5

1 is None, 5 is High
What is your daily stress level?

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2

3

4

5

1 is Low, 5 is High
Assisted StretchingFitness trainingBoth
GymAt home weightsNone of the aboveOther
In personOnlineHybrid
MondaysTuesdaysWednesdaysThursdaysFridaysSaturdaysSundaysNot sure yet
Improved healthImproved enduranceIncreased strengthIncreased muscle massFat lossReduce bodily tensionIncrease Range of MotionOther
Were you referred by anyone? if so by who
Please rate your readiness to change.

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2

3

4

5

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.*

Yes I understand
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