Muscles & Mascara Client Intake Form

Muscles and Mascara
PERSONAL TRAINER
832-401-8015
musclesandmascara@myyahoo.com
CLIENT INTAKE FORM
Current Fitness Level and Experience
How would you rate your current fitness level?
Do you currently follow a workout routine?

Other
Have you ever worked with a personal trainer before?

Other
What activities or exercises do you enjoy the most?
What activities or exercises do you dislike or wish to avoid?

832-401-8015

musclesandmascara@myyahoo.com
CLIENT INTAKE FORM
Lifestyle and Scheduling
How many days per week are you available for training?
What are your preferred training times? (Check all that apply)
Please describe your current stress level and any major stressors in your life:
Do you use any wearable fitness technology? (e.g., smartwatch, fitness tracker)

Other

Schedule:
What is your current occupation and typical work schedule?
832-401-8015
musclesandmascara@myyahoo.com
CLIENT INTAKE FORM
Privacy and Consent
Privacy Policy Acknowledgement:
By signing below, I acknowledge that I have read and understood the privacy policy regarding the use and protection of my personal data by this fitness training facility.
Signature:
Date:

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Consent for Participation:
I consent to participate in a fitness program provided by [Trainer's Name/Fitness Facility], understanding that all physical activities carry inherent risks. I have disclosed all relevant medical information and will notify the trainer of any changes in my health status.
Signature:
Date:

MonthDayYear
Date
Emergency Medical Consent:
In the event of a medical emergency, I consent to the administration of emergency medical care if deemed necessary.
Signature:
Date:

MonthDayYear
Date
Photography and Video Consent (Optional):I consent to the use of photographs and videos taken during training sessions for promotional purposes by [Trainer's Name/Fitness Facility].
Signature:
Date:

MonthDayYear
Date
Should be Empty: