Client Intake Form

Client Intake Form

FitMind Personal Training
Client Name*

First NameLast Name
Birth Date*

MonthDayYear
Date
Sex*
Phone Number*
Email*
example@example.com
Height (cm)*
Weight (kg)*
What best describes your experience in the gym?*

Advanced (5+yrs)Intermediate (2-5yrs)Experienced beginner (1-2yrs)Completely new (0yrs)
What best describes your current activity levels?*

Extreme/6-7 days exercise per weekHigh/4-5 days exercise per weekModerate/ 1-3 days exercise per weekLow/ No weekly exercise
How many days can you commit to exercising per week?*
Please select the best days you can exercise.*

MondayTuesdayWednesdayThursdayFridaySaturdaySunday
Please select the best times you can exercise.*

Early MorningsMorningsEarly AfternoonsAfternoonsEveningsLate Night
Where do you plan to exercise?*

HomeGymOther
If you selected gym, which gym? | If you selected home, what equipment do you have access to?
What is your motivation for joining the 8 Week Shred Challenge*
What would success look like for you at the end of 8 weeks?*
Please state if you have any current or previous health conditions, diseases and/or issues, or anything that may affect your ability to exercise.*
Please state whether you take any medication.*
Release and Acknowledgement
I, 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 aware that my information in this form will be kept confidential.

I understand this is an 8-week challenge, and results will depend on my effort and consistency.

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.
Full Name*
Date*

MonthDayYear
Date
Client Signature*

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Client Intake Form

Release and Acknowledgement