Personal Training Application 💪

Client Intake Form

You vs You by Aydin Mosaddad
First and Last Name

First NameLast Name
Age
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Emergency Contact
Please enter a valid phone number.Format: (000) 000-0000.
Instagram Handle (If applicable)
Height & Body Weight
Current Occupation and Hobbies
Health & Medical
Medical conditions affecting training (including any doctor guidance about working out or diet)
Any past or current injuries (please explain)
Current diet and any restrictions?
Current fitness routine (days per week, types of exercises, etc.)
Health & Lifesyle. Select if it applies to you
Top 3 fitness goals

Other
How is your fitness progress going?
What has been your biggest obstacle in the past?
What made you want to start training right now?
What type of coaching are you interested in?
Please select the best days you can exercise.
Please select the best times you can exercise.
How committed are you to making a change?

1

2

3

4

5

1 is 1 = Just exploring, 5 is 5 = All in, ready to invest and work hard
Release and Acknowledgement
I hereby acknowledge that the information I've given above is complete and accurate. I understand all the risks and I accept all the responsibility for any undesired situations during training. I am informed that my information in this form will be kept confidential.The online fitness coach has informed me that I am the only responsible party for all the injuries during the fitness program if any were to occur. I release and discharge the fitness coach from any disclosure of my personal information in this Fitness Client Intake Form.If any of my health, lifestyle or personal information/situation that may prevent my training is changed, I guarantee that I will inform the online fitness coach immediately.

Client Signature
Should be Empty:

Client Intake Form

Health & Medical

Release and Acknowledgement