Intake Form

Hi! I’m looking forward to working with you! Please fill this out before our assessment — it’ll help me get a better sense of where you’re at in your exercise journey, and how I can best help you accomplish your goals. Please answer all questions completely and to the best of your ability — it’s especially important for me to know about any existing medical conditions and / or injuries present so that we can train safely. I will keep your information private, and will only use your responses to build a training program that aligns with your abilities and goals.

Name

First Name

Last Name

Pronouns

Date of Birth

YYYY

How often do you engage in structured exercise?

This includes anything that you intentionally do to exercise — e.g., Running, walking, cycling, swimming, engaging in team sports, yoga, pilates, fitness classes, etc.

Do you have any medical conditions that either prevent you from exercising or require you to modify the way you exercise?

High blood pressure, asthma, heart disease, arthritis, etc.

If you answered 'Yes' above, please describe your condition and how it impacts your ability to exercise

Do you take any medications that effect your heart rate, blood pressure, or energy levels?

Blood pressure medication, beta blockers, diuretics, etc.

If you answered 'Yes' above, please list the medication:

Do you have any current injuries, or have you sustained any injuries in the past that might impact your ability to exercise?

Tendonitis, ankle sprains, plantar fasciitis, prior surgeries, knee pain, etc.

If you answered 'Yes' above, please explain your injury history in more detail:

What are your fitness goals?

This can be anything you'd like — common goals include learning to do a pull-up, being able to lift a certain amount of weight, mastering a specific exercise, feeling less intimidated at the gym, etc.

What's your learning style?

Do you learn best visually? Do you prefer to watch someone demonstrate an exercise before attempting it? Does it help to understand the 'why' behind something as you learn?

Is there anything else you'd like for me to know about you before we meet?

Waiver

Below are my training policies — please read and agree to each statement before we meet for our assessment.

Name

First Name

Last Name

Informed Consent

The client acknowledges, certifies, and accepts the following: That they are of adequate physical condition to participate in exercise despite any current medical conditions they may possess. That they assume the risk of physical injury from any advice, instruction, or action conducted during, or as a result of, a session with the Personal Trainer. That any discomfort, distress, or uncomfortable feelings will be immediately brought to the attention of the Personal Trainer. That they will not hold the Personal Trainer or its employer, affiliates, agents, or any other entity or individual connected to them, either directly or indirectly, liable for any result from the sessions. That they, the Client, assume all responsibility for a Client's participation in the sessions.

I have read and agree to the terms above

Training Expectations

Progress through training takes time, consistency, and effort. Every individual learns at a different pace, and while some people may see improvements quickly, meaningful and lasting results typically require continued practice and dedication outside of our sessions. Training is a process that builds over time, and success depends on your active participation and commitment. While I am dedicated to providing high-quality instruction and support, results cannot be guaranteed. Personal development is influenced by many factors, including your goals, mindset, and how much time and energy you invest between sessions. I’m here to guide and support you, but ultimately, your progress is shaped by the work you put in.

I have read and agree to the terms above

Cancellation Policy

Cancellations must be made at least 24 hours in advance of your scheduled session. If you cancel with less than 24 hours' notice, or fail to attend your appointment, you will be charged the full cost of the session. This policy is in place to respect the time set aside for your session and to allow for the opportunity to offer the time slot to others.

I have read and agree to the terms above

Intake Form

Waiver

Questions?