SMARINOVPT Client Intake Form

SMARINOV PT COACHING ENQUIRY

fill in the form below and I will get back to you as soon as possible
Part 1. Basic information
Full Name

First NameLast Name
Gender
Date of Birth

MonthDayYear
Height
cm
Weight
KG
Phone Number
E-mail Address
Instagram @
Part 2. Lifestyle Information
What do you do for a living?
Whats the activity level at your job?
Do you follow a regular working schedule, do you work days, afternoon or nights?
Please list the physical activities that you participate in outside of the gym and outside of work
Part 3. Medical and Health Information
Do you have any medical conditions?
If yes, please specify and list the condition(s).
If you are on any medications, please list them.
If you have any injuries, please list them.
Are you experiencing any stresses or motivational problems?
On average, how many hours of sleep do you get per night?
Part 4. Goals
Please rate your readiness for change.
What following goals does best fit in with your goals?
What is your goal with your training? Why? (If possible, provide a short, mid and long term goal)
What has been stopping you from reaching your goal?
Are you currently excersising regulary (at least 3x per week)?
If you currently exercise - in depth, please provide detail of your exercise history.
Have you trained with a personal trainer before?
What type of training are you looking for?
At what times during the day would you prefer to train?

Other
How often do you want to do Personal Training a week?
Please Choose
What are your expectations on me as your Personal Trainer/ Coach?
Please provide any exercises or foods that you would prefer to NOT to have in your tailored programme.
Please Read The Following Terms and Conditions
1.) CANCELLATIONS

Cancellations should be made at least 24 hours in advance of a scheduled session. Sessions cancelled less than 24 hours in advance will be charged in full to the client.

2.) LATE ARRIVALS

Each session shall be 1 hour in length. Sessions will not be extended (unless time is available) due to the lateness of the client or due to interruptions caused by the client.

3.) 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!
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SMARINOV PT COACHING ENQUIRY

Part 1. Basic information

Part 2. Lifestyle Information

Part 3. Medical and Health Information

Part 4. Goals

Please Read The Following Terms and Conditions