• Restore Haus Functional Training Membership Intake Form

    Please answer each question honestly. Your responses will be used to determine eligibility and guide your initial exercise program.

  • Personal Information

  • Format: (000) 000-0000.

  • Primary Goals

  • What are your primary goals? (Select up to 3)*

  • Current Activity Level

  • In the past 3 months, how would you describe your activity level?*
  • Which style of exercise do you generally enjoy most? (Select up to 2)*

  • Training Location & Equipment

  • Where will you complete most of your workouts?*

  • Required Equipment

    • Adjustable dumbbells or kettlebells
    • Long resistance band or tube resistance band
    • Mini resistance band
    • Aerobic step platform or sturdy step/stair access
    • Yoga or exercise mat
    • Sturdy chair, bench, or box
    • Skipping rope

  • Do you have access to all required equipment?*

  • This program is designed around the equipment listed above. If you do not currently have access to all required equipment, please review our Recommended Equipment Guide for approved equipment options and affiliate links.

    [View Recommended Equipment Guide]

    Please ensure all required equipment has been obtained before beginning your training program.

  • Health & Safety

  • This program is not appropriate for individuals who:

    • Are currently pregnant
    • Have been advised by a healthcare professional to avoid exercise
    • Have an uncontrolled medical condition that would make exercise unsafe
    • Are experiencing a recent injury or condition that requires medical assessment before beginning exercise
    • Have symptoms that would make independent exercise participation unsafe

  • Do any of the above apply to you?*

  • Based on your responses, this program is not appropriate for you at this time.

    Please follow the advice of your healthcare provider before participating in independent exercise. You're welcome to apply again once you've been medically cleared, if applicable.

  • Commitment

  • This membership is designed around a structured training plan consisting of three 1 hour exercise sessions per week for 12 weeks.

  • Can you commit to completing three 1 hour exercise sessions per week for the next 12 weeks?*

  • This membership requires consistent participation to achieve meaningful results. Based on your response, this program may not be the best fit at this time.

  • Posture Photos

  • Photo submission instructions:

    Please upload clear full body (head to toe) standing photos from the front, side, and back.

    Wear clothing that allows your posture and body position to be seen clearly.

    Stand naturally with your feet shoulder-width apart and your arms relaxed at your sides.

    Do not attempt to correct or change your posture for the photos.

    These images will be used for assessment purposes only.

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  • Movement Videos

  • Video submission instructions

    Please record and upload the following movement videos in a well-lit area with your full body visible throughout the recording.

    Move at a comfortable pace and only within a range that feels safe and tolerable. Some discomfort during movement may be expected and does not necessarily indicate harm. However, stop the movement if you experience severe pain, sharp or shooting pain, significant increase of symptoms, dizziness, loss of balance, or any symptom that feels unsafe.

    If you are unable to complete a movement due to symptoms, skip the movement and indicate this later in the form.

    These videos will be used to assess your movement patterns and current functional capacity.

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  • Waiver & Consent

  • Please review the Restore Haus Liability Waiver before continuing.

    View Agreement (PDF)

     

  • Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Should be Empty: