Client Intake Form for YL Fit&Wellness

Client Intake Form for YL Fit&Wellness

Please complete this form to help us tailor our services to your needs and goals.
Full Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Emergency Contact Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Accessibility & Communication Preferences
Hearing Status
Preferred Communication Method

Other
Do you need an interpreter or captioning?
Do you use any assistive devices? Please specify.
General Information
Place of Employment
How did you hear about YL Fit&Wellness?
Have you worked with a personal trainer before?
Prior injuries
If yes, please describe the injury
Provide details if applicable.
Fitness goal
Diet habits
Follow-up for weight loss.
Exercise habits
Follow-up for muscle gain.
Time preference
Preferred days for sessions
Preferred time windows for sessions
Example: 6-8 AM or 5-7 PM.
Thank you for completing the intake form!
Please submit your completed form by emailing it to ylfit.wellness@ylfitwellness.com.
If you have any questions, feel free to contact us.
If yes, please share details about your experience with personal trainers.
What are your fitness and wellness goals?
Should be Empty: