New Client Fitness Intake Form
Full name:
Age:
Sex:
Current weight:
Email:
Cell phone:
What is your main fitness goal? Weight loss, muscle gain, improve endurance, overall health
What is your current level of physical activity?
Do you have any past or current injuries medical conditions or limitations? Please explain
What has your experience been with fitness in the past? Played sports, gym, fitness classes
What does a typical day of eating look like for you? Meals, snacks, timing , diets.
How many days per week can you realistically commit to working out? Please include the days
Do you have access to a gym or home workout equipment?
On a scale of 1 to 10 how motivated are you to start and stick to a program?
What are your biggest obstacles when it comes to fitness and health?
How would you like to be supported from a coach?
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Do you have an food intolerances or allergies?
What are your short term and long term fitness goals?
How would you describe your stress levels?
What do you enjoy doing when it comes to fitness? Is there anything you don’t enjoy?
What challenges have you faced in your fitness journey?
How do you want to feel at the end of this journey?
Is there anything else you’d like to share?
Client Acknowledgement & Assumption of Risk: I (the client), understand that the fitness coaching services provided by my coach (Ariana Mouratidis) are delivered remotely and may include recommendations for physical activity, exercise routines, and general nutrition guidance.I acknowledge that: I am voluntarily participating in this program at my own risk. I understand that physical activity can involve inherent risks, including potential injury or discomfort. I affirm that I am in good physical condition to participate, or I have consulted a medical professional who has cleared me for exercise. I will inform the Coach of any changes to my health, physical condition, or limitations that may affect my participation. Release of Liability: I hereby release and discharge the Coach from any and all claims or liabilities, known or unknown, arising from or related to my participation in this program. I understand that the Coach is not a medical professional and that all advice is intended for educational and informational purposes only. Acknowledgement of UnderstandingI have read this waiver and understand its contents. By signing below, I agree to its terms and acknowledge that I am participating in the program voluntarily.
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