New Client Intake Form
Section 1: About you
Full name
Email
example@example.com
Phone number
Please enter a valid phone number.
Format: (000) 000-0000.
In person at The Vault Fitness, or online coaching?
In person at The Vault Fitness
Online coaching
What is your main goal?
Lose weight
Build strength
Move pain-free
Mobility
General fitness
Age
How did you hear about me?
Instagram
referral
The Vault
other
Section 2: Your goal
Anything specific you want to achieve? A deadline, an event, a number?
Section 3: Health check (PAR-Q style)
Do you have high blood pressure, diabetes, or any other medical condition I should know about?
*
Yes
No
Please explain if needed
Are you on any medication that affects exercise?
*
Yes
No
Please explain if needed
Has a doctor ever told you that you have a heart condition?
*
Yes
No
Do you feel pain in your chest during physical activity?
*
Yes
No
Have you been cleared by a doctor or physio to exercise?
*
Yes
No
Not sure
Any injuries, past or current? Where, and when?
*
Any areas that hurt, feel stiff, or never move right?
*
Section 4: Training and lifestyle
Training history in one or two lines:
Best days and times for you?
Section 5: Consent
I confirm my answers are accurate and I understand training carries normal physical risk. I will tell my coach about any change in my health.
*
I understand this form is not medical advice and does not replace my doctor.
*
Submit
Should be Empty: