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Personal Training Intake Form
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Please provide your full name:
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Your answer
Please provide your age:
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Your answer
Please provide your phone number
(eg: xxx-xxx-xxxx)
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Your answer
Please provide your email address:
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Your answer
What are your preferred pronouns?
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Your answer
Do you have any medical conditions, previous or current injuries, or general concerns about exercise?
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Your answer
Briefly describe your motivations & goals in starting or enhancing your fitness routine (I.e. Feel better, weight loss, endurance, cardiovascular health, etc.)
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Your answer
What is/are the best time(s) of day for you to train?
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Early Morning (6am-9am)
Morning (9am-12pm)
Afternoon (12pm-5pm)
Evenings (5pm-8pm)
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What are the best days of the week for you to train?
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Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
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On average, how many hours of sleep do you get a night?
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Your answer
Do you have a consistent sleep schedule, or do you struggle with irregular sleep patterns? If so, what barriers do you face in maintaining a regular sleep schedule? I.e. work, stress, home life, screen time
etc.
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Your answer
How would you describe your current stress levels?
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Your answer
What are the main factors in your life that contribute to your stress? I.e. work life, family, schedule etc.
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Your answer
What does a typical day of eating look like for you? (I.e. How many meals a day? When do you eat? What types of food?)
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Your answer
How satisfied do you feel with your eating habits and nutrition? Is there anything specific you would like to change?
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Your answer
On a scale of 1-10, how physically active are you currently?
Not Very Active
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Extremely Active
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Briefly describe your exercise experience over the past few years:
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Your answer
Have you ever worked with a personal trainer/coach? What was that experience like for you?
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Your answer
Briefly describe what barriers you have faced in starting or maintaining a fitness routine:
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Your answer
On a scale of 1-10, how ready are you to make positive & long lasting changes to your fitness routine?
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Not Ready
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Extremely Ready
Is there anything else you would like to share regarding your fitness routine, lifestyle, questions/concerns, etc.?
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Your answer
Which of the following services are you interested in pursuing?
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Group Hatha Yoga Class ($15 drop-in)
1:1 Personal Training 60 min, $55 per session
1:1 Personal Training 30 min, $35 per session
Semi-Private Personal Training 2:1 & 3:1 60 min, $35 per session/person
Other:
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