Personal Training with Leslie Lissaint:             Client Physical Intake Form
Hey, so glad you are interested in personal training with me, it will be journey. Before we get started please take some time to fill out this physical intake form which will help me get to know you and your goals in order to design the best work out plan for you. (Updated as of Feb 2022)
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First & Last Name *
Email Address *
Phone Number *
Home Address *
Birth date *
Current age *
Height *
Current weight *
What are your personal fitness goals? *
Required
Other fitness goals ( not listed from above)
Do you exercises regularly? *
Rate your overall activity level *
Rate your experience with exercises *
Have you ever lifted weights before? *
Is there anything you love about exercising? ( if none write none) *
What equipment do you have access to? *
Do you have a gym membership? *
If yes, which gym and location(s)? *
On which days are you available to work out? *
Required
How frequent would you like to work out? *
What time frame would you like to work out? *
What do you expect from your trainer/coach? *
Do you have any existing injuries or health conditions that I should be aware of? (If no write n/a, if yes please explain in detail) *
What date do you want to start training together?
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Are you prepared to commit to training for at least 3 months together? *
In addition to the time commitment, there is also a financial commitment. Are you prepared financially? *
Next steps:
Once completed I will send a follow up email with you so that we can discuss answers and work out plan together.
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