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Breakthru Fit Studio Client Intake Form 2022
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Email *
Full Name *
Phone Number *
How did you hear about our us? *
Gender - Female *
Date of Birth *
City *
What type of training are you most interested in doing? *
Required
If you plan on doing our Small Group Personal Training workouts, what are the ideal days you are looking to attend? *
Required
If you plan on doing our Small Group Personal Training workouts, what are the ideal times you are looking to attend? *
Required
If you plan on working with a specific  personal trainer, please enter their name below.  
Tell us a little bit about yourself.
HEALTH / MEDICAL - We require participants and trainers to be fully vaccinated against Covid-19.  Please confirm  that you are FULLY vaccinated below *
Required
HEALTH / MEDICAL - Are there any health concerns, medications or injuries that I need to know about? *
List your emergency contact person, relationship & their cell phone number: *
GOALS / CHALLENGES - What are 2 or 3 of the most important goal you want to achieve?  Why is this so important to you right now?  What is the biggest obstacle that you need to overcome to make this happen? *
What do you do for a living? *
WORKOUT HISTORY- What is your current workout history?  What type of workout are you doing now? What do you feel might be missing that you'd like to include?   *
STRESS - How would you rate your current level of stress? *
SLEEP - How would you rate your current quality of sleep? *
NUTRITION - How would you rate your current eating habits? *
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