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
What are your personal fitness goals?
Health ( General)
Toning and Shaping
Other fitness goals ( not listed from above)
Do you exercises regularly?
I currently exercises regularly
I used to exercieses regularly
I have never exercised 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?
Free weights ( dumbbells/ barbells)
Squat rack or Smith Machine
TRX suspension Training
Cardio Machine ( treadmill, elliptical, row machine)
Track or open space to run
Do you have a gym membership?
If yes, which gym and location(s)?
On which days are you available to work out?
How frequent would you like to work out?
2 X per week
3 X per week
4 X per week
5 X per week
What time frame would you like to work out?
Mornings ( 6am-11am)
Afternoons ( 12pm-4pm)
Evenings ( 5pm-9pm)
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?
How long are you interested in training together?
Five months or longer
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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