New Client Intake Information
All information submitted will remain confidential and not sold or shared with any person or third party companies.
*Please read carefully and fill out all sections thoroughly*
Name
*
First Name
Last Name
Email
*
Age
*
Where are you located?
*
Please indicate time zone as well.
Gender
*
Male
Female
Prefer not to say
Other
What is your current weight
*
Height
*
Resting/Waking Heart Rate
*
If unsure, leave N/A
Blood Pressure
*
If unsure, leave N/A
Client Questionnaire
What are your goals? Please be as specific as possible
*
What's your current activity level? Please tell us about your typical exercise routine (i.e. type of exercise, duration, days per week). Please be as specific as possible.
*
Are you currently pregnant, postpartum, breastfeeding, or trying to conceive?
*
Do you have a diagnosed health problem? If so, please elaborate.
*
Please be very thorough
On a scale from 1-10, how committed are you to achieving your goals?
1
2
3
4
5
Worst
Best
1 is Worst, 5 is Best
Anything else you'd like for me to know?
*
Please be very thorough
Submit
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