Fitness Client Intake Form

Health & Lifestyle

Rows	Yes	No
Do you smoke?
Have you had any surgery since one year?
Do you drink alcohol?
Are you using any additional vitamin or supplements?
Are you tracking your daily food intake?
Have you done sports professionally before?
Do you feel pain while doing sports/exercise?

What is your rate for your nutrition?

0

1

2

3

4

5

0 is Poor, 5 is Excellent
What is your current activity level?
What type of exercise are you currently doing?

Other
Have you ever worked with a trainer before?
How many days can you exercise per week?
Please select the best times you can exercise.
What are your goals for training?

Other
Do you have access to a gym or home equipment?

Other
On average, how many meals/snacks do you eat per day?
Do you follow a specific diet?

Other
Do you track your daily macros?
How much water do you drink daily on average?
Release and Acknowledgement
I, {clientName}, hereby acknowledge that the information I've given above is complete and accurate. I understand all the risks and I accept all the responsibility for any undesired situations during training. I am informed that my information in this form will be kept confidential.

The fitness center has informed me that I am the only responsible party both for all the injuries during the fitness program and incorrect information. I release and discharge the fitness center trainers, administration and workers from any disclosure of my personal information in this Fitness Client Intake Form.

If any of my health, lifestyle or personal information/situation that may prevent my training is changed, I guarantee that I will inform the fitness center authorities immediately.
Date

MonthDayYear
Date
Client Signature
Should be Empty:

Release and Acknowledgement