• Tier 1 Client Intake — Functionally Fitness

    Welcome aboard. This intake tells me everything I need to build your individualized program — your history, your goals, and anything I need to train around. Set aside about 10-15 minutes. The health screening section matters most, so please answer it carefully and honestly. Everything you share is confidential.

  • Contact & Basics

  • Format: (000) 000-0000.
  • Date of Birth*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Biological Sex*
  • Format: (000) 000-0000.

  • Goals

  • Primary training goal*
  • Secondary goals

  • Health Screening

  • These are standard pre-exercise screening questions. Answering yes to one or more doesn't mean you can't train — it means I need to know before I program for you, and in some cases I'll ask you to get clearance from your doctor first.
  • 1) Do you have a heart condition, or has a doctor only recommended physical activity that you should do?*
  • 2) Do you experience chest pain during physical activity?*
  • 3) Have you had chest pain in the past month while not doing physical activity?*
  • 4) Do you experience dizziness, loss of balance, or have you ever lost consciousness?*
  • 5) Do you have a bone or joint problem that could be worsened by a change in physical activity?*
  • 6) Is a doctor currently prescribing drugs for blood pressure or a heart condition?*
  • 7) Is there any other reason you should not do physical activity?*
  • You answered yes to at least one screening question. That's common and usually not a barrier — but before we begin training I'll need written clearance from your physician. I'll send you a clearance form to take to your appointment, and we can start planning in the meantime.

  • Medical & Injury History

  • Current health conditions
  • Pregnancy or postpartum status
  • Current pain locations
  • Physical therapy in the past 2 years

  • Training Background

  • Current training experience*
  • How long have you been training consistently in your current routine?*
  • Comfort with barbell lifts*
  • Types of training you enjoy

  • Schedule & Equipment

  • Training days per week*
  • Typical session length*
  • Usual time of day to train*
  • Primary training location*
  • Equipment available to you
  • Can you film lifts and send them for form review?*

  • Lifestyle

  • Average sleep per night*
  • Job activity level*
  • Daily steps*
  • Current nutrition*
  • Tobacco or nicotine use*
  • Alcoholic drinks per typical week*

  • Coaching & Communication

  • Coaching Style Preference*
  • Best Way to Reach You*
  • Desired Accountability Level*
  • How Did You Hear About Functionally Fitness?*

  • Agreement

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