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Client Intake Form
Email address *
What brought you here, why do you want to work with me?
Your answer
What are some outcome based goals you want to achieve? These are goals that will be a byproduct of your hard work in the coming weeks.
Your answer
Have you ever had any injuries/do you presently have any injures that would affect your training?
If you answered yes or maybe, please explain.
Your answer
Do you have gym intimidation? What would you say your level of fitness is, with 1 being zero experience at all and 10 being experienced and confident with a variety of exercises.
Your answer
Has your doctor ever said that you have a heart condition?
If you answered yes, please explain what your condition is.
Your answer
Do you ever feel pain in your chest while at rest and/or while performing physcial activities?
Do you lose balance because of dizziness or have you lost consciousness in the last 12 months?
If you answered yes to the previous question, please explain the situation.
Your answer
Has your doctor ever diagnosed you with a chronic health condition?
If you answered yes, please explain what your condition is.
Your answer
Please list all medications you are currently taking.
Your answer
Do you have any food allergies or aversions?
If you answered yes, list your allergies or aversions.
Your answer
If I presented you with a list of foods and asked you to tell me which foods were a protein source, a carb source and a fat source, would you feel confident in your answers?
Are there any foods you're afraid to eat for any reason at all?
If you answered yes or somewhat, what foods are you afraid of? Do you know why?
Your answer
What is your favorite form of exercise?
Your answer
What is your least favorite form of exercise?
Your answer
Is there anything specific you want to work on that I should know about?
Your answer
Are you ready to nourish your body, have bad ass workouts, and flourish?
A copy of your responses will be emailed to the address you provided.
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