• Tier 3 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 — plus we'll get your weekly in-person sessions scheduled. 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*
  • Military Affiliation*
  • 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.
  • Do you have a heart condition or has a doctor ever told you to do physical activity only as prescribed by a doctor?*
  • Do you experience chest pain during physical activity?*
  • Have you had chest pain at rest in the past month?*
  • Do you lose your balance because of dizziness, or do you ever lose consciousness?*
  • Do you have a bone, joint, or other problem that could be made worse by a change in your physical activity?*
  • Are you currently taking prescription drugs for blood pressure or a heart condition?*
  • 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.
  • Have you already been cleared by a physician for exercise?

  • Medical & Injury History

  • Current medical conditions (select all that apply)*
  • Pregnancy or postpartum status*
  • Current pain locations
  • Physical therapy in the past 2 years

  • Training Background

  • Current training experience level*
  • How long have you been training consistently in your current routine?*
  • Comfort with barbell lifts*
  • Training styles you enjoy
  • Have you worked with a personal trainer before?*

  • Your In-Person Sessions

  • Tier 3 includes two to three in-person sessions with me each week. Let's find times that work with your schedule.
  • Preferred number of in-person sessions per week*
  • Select all that could work*
  • Preferred time of day*
  • Scheduling preference*
  • How far are you willing to travel*

  • Your Solo Training Days

  • Do you want programming for additional solo training days?*
  • If yes, how many additional solo training days per week?
  • What equipment will you have access to on solo training days?

  • Lifestyle

  • Average sleep per night*
  • Job activity level*
  • Approximate daily steps*
  • Current nutrition habits*
  • Tobacco or nicotine use*
  • Typical weekly alcoholic drinks*

  • Coaching & Communication

  • Preferred coaching style*
  • Best way to reach you between sessions*
  • Desired accountability level*
  • Likely cancellation/rescheduling situation*
  • How did you hear about Functionally Fitness?*

  • Agreement

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