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Client Intake Form
Complete the form below to become a potential client of Bold Behavior Fitness. 
Information in this application is kept in strict confidence.
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First & Last Name *
Email *
Phone Number *
How old are you? *
What is your gender? *
What city/state are you located? *
Which type of training are you interested in? 
(In-person training is only available to those who live in Charlotte, North Carolina)
 *
Do you now, or have recently experienced any of the conditions listed below? *
Required
How would you rate your current fitness level? *
Required
What is your current weight? *
Please tell me your desired weight?
What are your personal fitness goals? Please be as detailed as possible. *
On scale of 1-10 how committed are you to starting this fitness program? *
Rate yourself... *
Poor
Moderate
Excellent
Amazing!
Balance
Stamina
Flexibility
Strength
Mobility
When are you ready to began training?
 (No training on Saturdays and Sundays)
 *
MM
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How did you hear about Bold Behavior Fitness? *
What is your instagram/facebook handle? I would love to follow you back!
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