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Personal Training Client Intake Form 2021
Email *
First & Last Name *
Cell Phone # *
Gender *
Date of Birth *
Your address *
What type of training are you most interested in doing? *
Required
List your emergency contact person, relationship & their cell phone number: *
Tell me a little about yourself: *
HEALTH / MEDICAL - Are there any health concerns or injuries that I need to know about? *
GOALS / CHALLENGES - What is the single 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? *
STRESS - How would you rate your current level of stress? *
Low Stress
High Stress
SLEEP - How would you rate your current quality of sleep? *
Great Sleep
Poor Sleep
NUTRITION - How would you rate your current eating habits? *
Poor Eating Habits
Healthy Eating Habits
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