Online Programming Intake Form

Online Programming Intake Form
Full Name

First NameLast Name
Email
Phone Number
What are your goals for online programming (select all that apply)

Other
Are you training for a specific sport/event?
Any other details you want to share about your training goals?
How often do you currently train?
How frequently can you commit to training? This will tell me how many days I will need to program for you?

Other
What are your expectations of me as your coach?
Are you interested in a gym membership? *Includes remote access to our facility 24 hours a day, 365 days per year
Medical and Health Information
Please list any health issues (or medications) that could impact our training together.
Please list any injuries that could impact our training together, and if any additional therapies are being undertaken to address the injury.
Please Read The Following Terms and Conditions
1.) CANCELLATIONS

Cancellations to our contract should be made at least 7 days in advance of your next billing cycle. Contracts cancelled less than 7 days in advance will be charged in full to the client.

2.) ALL THE INFORMATION I HAVE GIVEN IS CORRECT

All the information on this form is correct and to the best of my knowledge. I have sought and followed any necessary medical advice. I understand that all the information given will be kept confidential.
I AGREE TO THE ABOVE TERMS & CONDITIONS
Thank you for your interest! We will review your intake form and get back to you within 48 hours.
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Please Read The Following Terms and Conditions