Training Consultation Intake Form
Please complete this form to help us understand your background, goals, and needs for your training consultation.
Full Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
What is your number one goal that you would like to achieve?
*
Outline what obstacles in your life may hold you back from this goal.
Is there anything else you would like to accomplish through training?
Is there anything else you would like me to know?
Current bodyweight (lbs or kg)
List any current medical conditions.
List any medications and supplements you’re currently taking.
What is your occupation?
How many hours a week do you work?
What are the common postural and work demands of your job?
Are you a student?
Yes
No
Do you play any sports?
Yes
No
Do you have any chronic aches and pain?
Do you have any movement restrictions?
Do you devote any additional time to rehabilitative/preventative mobility measures?
Yes
No
Rate your daily life stress level on a scale of 1-10
Low
1
2
3
4
5
6
7
8
9
High
10
1 is Low, 10 is High
How many hours do you sleep on an average day?
How many hours do you spend on electronics on an average day?
Do you count macros or follow a meal plan? If so, please explain.
How many meals do you consume on an average day?
How much water do you consume on an average day? (liters or ounces)
On a scale of 1-10, rank the level of your general digestive health (consider factors like bloating, regularity, specific food intolerances, etc.).
Poor
1
2
3
4
5
6
7
8
9
Excellent
10
1 is Poor, 10 is Excellent
How many days a week do you currently train on average?
How long is each average training session? (minutes)
What does an average training session consist of?
Do you do any dedicated cardiovascular training?
Yes
No
List equipment access.
Write out in the closest detail possible your last 2-4 weeks of training.
Submit
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