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 Oct 22, 2018)
First & Last Name *
Your answer
Email Address *
Your answer
Phone Number *
Your answer
Home Address *
Your answer
Birth date *
Your answer
Current age *
Your answer
Height *
Your answer
Current weight *
Your answer
What are your personal fitness goals? *
Required
Other fitness goals ( not listed from above)
Your answer
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) *
Your answer
What equipment do you have access to? *
Do you have a gym membership? *
If yes, which gym and location(s)? *
Your answer
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? *
Your answer
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) *
Your answer
What date do you want to start training together?
MM
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DD
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YYYY
How long are you interested in training together? *
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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