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Intake Form

First name

Last name

Phone

How did you hear about us?

How would you describe your current physical activity level?

What types of physical activity do you currently do?

How many days per week can you realistically commit to exercise?

1-2 Days

3-4 Days

5+ Days

Single choice

Option 1

Option 2

Where do you prefer to work out?

Home

Gym

Do you have access to workout equipment? If yes, what equipment do you have access to?

Do you have any current or past health conditions? If yes, please describe:

Do you have any physical limitations we should be aware of? If yes, please describe:

What are your short-term fitness goals? (3-6 months) What are your long-term fitness goals? (6-12+ months)

Is there anything that might prevent you from exercising consistantly? (work schedule, motivation, lack of energy)

Is there anything else you'd like me to know to help you reach your goals?