• Virtual Training Intake Form

  • Client Information

  • Date of Birth*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Format: (000) 000-0000.
  • Preferred Contact Method*
  • Desired Start Date*
     - -
    2 digit month, 2 digit day, 4 digit year

  • Fitness Goals

  • Primary Goal*
  • Areas of the Body to Focus On

  • Current Fitness & Lifestyle

  • Current activity level*

  • Virtual Training Setup

  • Live virtual training sessions will be conducted through Zoom. You’ll need a suitable space and setup where Coach E can see you clearly and you can exercise safely during the session.
  • Do you have a suitable setup for live Zoom training?*
  • Where will you train?*
  • Equipment available
  • Do you have gym access?*
  • Preferred training days
  • Preferred workout length

  • Health & Exercise Readiness

  • Do you have any current or previous injuries, surgeries, or chronic conditions?*
  • Do you have any joint or mobility limitations?*
  • Have you experienced any cardiovascular concerns or symptoms during activity?*
  • Are you currently pregnant or postpartum?*
  • Do you take any medications that may affect exercise?*
  • Has a physician or other healthcare professional ever advised you to restrict exercise?*
  • Is medical clearance needed before starting virtual training?*

  • Nutrition & Habits

  • Current eating pattern*
  • Do you track calories or macros?*
  • Would you like nutrition guidance included in your coaching?*

  • Accountability & Coaching

  • Preferred accountability style*

  • Emergency Contact

  • Format: (000) 000-0000.

  • Available Payment Methods

  • Virtual training is $120 per month and MUST be paid before training slot is reserved. Available payment methods include:

  • Cash App — $EricaJordan901

    Apple Pay or Zelle 901-937-9441

  • Which payment method do you plan to use?*

  • Client Acknowledgment & Consent

  • Training Price Acknowledgment*
  • I confirm the following*
  • Should be Empty: