KF Performance Training Inquiry Form
Full Name
*
First Name
Last Name
Phone Number
*
Format: (000) 000-0000.
E-mail
example@example.com
Gender
Female
Male
Date of birth
-
Month
-
Day
Year
Date
Age
Height
Current weight (lbs)
Lifestyle Information
What do you do for work?
What is the activity level at your job?
None (mostly seated)
Moderate (light activity such as walking)
High (heavy labor/ very active)
What’s your work schedule like? Day/office hours, nights?
List what a typical day of eating looks like for you (ex: breakfast, lunch, dinner)
Training experience:
Beginner
Intermediate
Advanced
What type of training (if any) do you do currently? (Ex: CrossFit, HIIT, strength etc)
What are your personal fitness goals?
Health history
1. Has a doctor ever said you have a heart condition?
Yes
No
2. Do you experience chest pain during physical activity?
Yes
No
3. Do you lose balance due to dizziness or ever lose consciousness?
Yes
No
4. Do you have any bone, joint, or muscular problems that could be worsened by exercise?
Yes
No
5. Do you have any other reason you should not do physical activity?
Yes
No
If “yes” to any questions 1-5, please briefly explain and note whether you have a medical clearance to exercise.
Diagnosed Medical Conditions
High blood pressure
Asthma/ breathing conditions
Diabetes/ blood sugar regulation
Thyroid condition
PCOS
Heart condition
Autoimmune condition
None
Other (please list below)
If other, please list diagnosed medical conditions
Injuries, pain, or physical limitations
Knee
Shoulder
Back
Hips
None
Other
If other, please describe any physical limitations and movements you avoid or can’t perform comfortably.
Are you currently taking any medications that may affect exercise performance (e.g. heart rate, blood pressure, breathing, recovery)?
Yes
No
If yes, please provide brief description.
Are you currently pregnant or have been pregnant in the past 12 months?
Yes
No
If yes, have you been cleared for exercise by a medical professional?
Do you have any other medical conditions or diagnosis that you think I should be made aware of that would prohibit you from exercising?
Current physique
Please upload three photos of your front, back and side. No mirror photos. Please wear a bikini or minimal form fitting clothing (sports bra + shorts are ok). Do not upload nude photos. No mirror photos or selfies. Natural lighting is preferred.
Physique front (relaxed, arms by your side)
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Physique back (relaxed, arms by your side)
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Physique side (stand with arms extended in front of you)
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These photos are used only to assess posture, starting point, and progress over time. All photos are kept private and confidential. Photos will never be shared without clients permission. If you are uncomfortable uploading photos please note this below and we will work out an alternative way to track progress.
Tell me about yourself! Hobbies, interests, passions, goals? Is there anything else you want me to know?
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