Personal Training Intake Form
Personal In-Home + Outdoor Training Packages:

*1 hour sessions

Single Session $85

5 Sessions $350, $70/hr

10 Sessions $650, $65/hr

​Thanks for your interest in training with Jess!

Jess trains her clients out of a gym at 15th and Chestnut Streets.

Please complete this form and she will be in touch with you to schedule your free initial assessment + goal planning session.

Email *
Name (first, last) *
Date of Birth *
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Phone Number *
E-Mail *
Address *
Occupation (Company, Job Title) *
Have you worked with a personal trainer before? If so, what things did you like? What things didn't you like? *
Why do you want to work with a personal trainer? *
What is your current fitness routine? *
What are your fitness goals? *
Please describe a time in your life you were most happy about your fitness level and routine? *
I am interested in: *
Required
How many days per week do you want to train with Jess *
Jess trains her clients out of a gym located at 15th and Chestnut St. Do you agree to meet Jess at this location at the time of your scheduled sessions together? *
What is your availability to train? Please include mornings, afternoon, or evening hours and days of week. *
Have you had or do you have any medical conditions or take any medications? What are they? *
If yes to the question above, have you been cleared by your Doctor to work out? Can you provide a Doctor's clearance note if requested? *
Please describe any significant injuries you've had in the past 6 months, or indicate the time frame of an injury if you still experience discomfort or pain. *
Lastly, is there any thing else you want Jess to know that could affect your training, or ability to train consistently?
A copy of your responses will be emailed to the address you provided.
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