• Flow’er Client Intake Form

    Flow’er Client Intake Form

    Please fill out your personal and health information to get started with your wellness journey.

  • Personal Information

  • Gender
  • Format: (000) 000-0000.

  • Emergency Contact

  • Format: (000) 000-0000.

  • Fitness Goals

  • Select your fitness goals (choose all that apply):*

  • Health History

  • Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?*
  • Do you feel pain in your chest when you do physical activity?*
  • In the past month, have you had chest pain when you were not doing physical activity?*
  • Do you lose your balance because of dizziness or do you ever lose consciousness?*
  • Have you ever had a bone or joint problem (for example, back, knee, or hip) that could be made worse by a change in your physical activity?*
  • Are you currently pregnant or have you given birth in the last 6 months?*
  • Are you currently taking any prescribed medications?*
  • Do you have any chronic medical conditions (such as diabetes, asthma, epilepsy, etc.)?*

  • Nutrition Habits Overview

  • Equipment Availability

  • Select all equipment you have available:*

  • Availability and Preferred Training Times

  • Coaching Preferences and Learning Style

  • How do you prefer to receive coaching and feedback?
  • What is your preferred learning style?

  • Liability Waiver and Consent

  • Date*
     - -
  • FLOW’ER Intro Session
  • Should be Empty: