Fitness Client Intake Form

Client Name

First NameLast Name

Birth Date

Date

Phone Number

Format: (000) 000-0000.

Email

example@example.com

Please list any current or previous health conditions/complications

What are your goals?

Other

Which service are you interested in?

How many days of activity do you get per week? (This can include days of exercise AND any days of higher activity such as yard work)

I, {Client Name}, hereby acknowledge that the information I've given above is complete and accurate. I understand all the risks and I accept all responsibility for any undesired situations that may come as a result of coaching/training. I am informed that my information in this form will be kept confidential.

I recognize that I am the only responsible party both for any potential injuries during training/coaching or providing incorrect information. I release and discharge the fitness trainer (Noah Bernacki) of all liability relating to the services provided.

If any of my health, lifestyle or personal information/situation that may prevent my training is changed, I guarantee that I will inform the fitness center authorities immediately.

Date

Client Signature

Fitness Client Intake Form

Release and Acknowledgement