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?

Beginner (No experience or exercise in a long time)Intermediate (Some experience and regular exercise)Advanced (Regular and intensive exercise, familiar with various workouts)
Do you currently follow a workout routine?

NoOther
Have you ever worked with a personal trainer before?

NoOther
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)

Early Morning (5 am - 8 am)Late Morning (8 am - 12 pm)Afternoon (12 pm - 4 pm)Evening (4 pm - 8 pm)Late Evening (8 pm - 10 pm)Flexible
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)

NoOther

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:

Clear
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:

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Date:

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

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Date:

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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].

YesNo
Signature:

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Date:

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Should be Empty: