Williams Performance ATX – Client Intake Form

Full Name* This field is required.

First Name

Middle Name

Last Name

Age* This field is required.

Height (Feet & Inches)* This field is required.

Weight (Pounds)* This field is required.

Phone Number* This field is required.

Area Code

Phone Number

Personal Email Address* This field is required.

example@example.com

Have you followed a structured workout program before?* This field is required.

Experience with weight training* This field is required.

Consistency of training in the past 3 months* This field is required.

Sports or athletic background* This field is required.

Exercises you are familiar with performing* This field is required.

Squats

Deadlifts

Bench press

Overhead press

Rows

Pull-ups or assisted pull-ups

Lunges

Push-ups

Core exercises

Other

Confidence performing exercises on your own without a trainer* This field is required.

Not confident

Very confident

Have you worked with a personal trainer or coach before?* This field is required.

What did you like or dislike about that experience?

Current or past injuries affecting exercise?* This field is required.

If yes, describe the injury, location, and any limitations* This field is required.

Current pain or discomfort?* This field is required.

If yes, describe the location, type, and when it occurs* This field is required.

Diagnosed medical conditions?* This field is required.

If yes, please list the condition(s) and any relevant details* This field is required.

Under a doctor's care or advised to limit physical activity?* This field is required.

If yes, please explain any guidance or restrictions* This field is required.

Currently prescribed physical therapy or corrective exercise?* This field is required.

If yes, please describe the program and any restrictions* This field is required.

History of heat-related injury?* This field is required.

If yes, please provide details* This field is required.

History of cold-related injury?* This field is required.

If yes, please provide details* This field is required.

Taking medication that may affect exercise performance or safety?* This field is required.

If yes, list medications or note "prefer to discuss in person"* This field is required.

Currently cleared by a physician to participate in physical exercise?* This field is required.

Daily activity level at work* This field is required.

Average hours of sleep per night* This field is required.

Sleep quality* This field is required.

Current stress level* This field is required.

Weekly physical activity outside structured workouts* This field is required.

Recovery tools used weekly* This field is required.

Foam rolling

Stretching/mobility work

Massage

Ice or contrast therapy

Compression therapy

Sauna

Breathwork or meditation

Percussion massage device

Other

Current diet* This field is required.

What does a normal day of eating look like?* This field is required.

Average daily water intake* This field is required.

Food allergies or dietary restrictions?* This field is required.

Please list any allergies, restrictions, or foods you avoid* This field is required.

Do you currently take any supplements?* This field is required.

Please list your current supplements* This field is required.

Training goals* This field is required.

Build strength

Improve speed

Increase endurance

Improve mobility/flexibility

Lose fat

Build muscle

Enhance sport performance

Recover from injury

Improve conditioning

Other

Main goal right now* This field is required.

Secondary goal, if any

Are you training for a specific deadline or event?* This field is required.

Event, season, tryout, test, or deadline details* This field is required.

What does success look like in 90 days?* This field is required.

What does success look like in 12 months?