Barbell Medicine New Client Intake
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Email *
I am interested in the following *
Name *
Age *
Gender *
Height *
Height Units *
Body Weight *
Body Weight Units *
Waist Circumference
Waist Circumference Units
What are your goals? Please be as specific as possible. *
If you are currently training, please provide your current  squat, bench press, and deadlift numbers. Please include weights, units, and repetitions.
How many days per week do you train, if you are currently doing so? What does your week look like from an exercise perspective?
Are you currently or previously injured? Are there any movements you cannot perform?
What type of training facility do you use now or have access to?  What equipment do you have?
If you are interested in nutrition coaching, what has your body weight trend been recently?
Have you used any diet interventions in the last six to twelve months? If so, what intervention and how did that go?
Please describe any allergies, diseases, or disorders you have.
Please include any other pertinent info that you think our coaches should know.
A copy of your responses will be emailed to the address you provided.
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