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Intake form

First name

Last name

Date of birth

Year

Month

Day

Diagnosed mental and/or physical health condition(s), or anything else that you believe could impact your training?

Family history of heart disease, diabetes, asthma, high or low blood pressure?

Previous or current injury?

Previous or planned future surgeries?

Have you had a personal trainer before? If so, what kind of training did you do?

Describe your previous experience with diets and/or workout plans. What worked for you, and what did not?

How much time can you commit towards your health? How much do you currently commit?

What are three fitness goals you would like to focus on?

What keeps you motivated and helps you stay on track?

How will you know when you are getting results?

What do you expect from me as your personal trainer?