New Client Intake Form

Help Us Get to Know You

This form allows us to get to know you, understand your goals and your athletic, training, and injury history in order to coach you as effectively as possible.

"*" indicates required fields

Name*
Address*
What do you do for a living?

EMERGENCY CONTACT INFORMATION

Emergency Contact (Name)*

WORKOUT PREFERENCES

Target # of Workouts Per Week?*
Preferred Workout Days*
Preferred Workout Times*

FITNESS GOALS

What do you want to accomplish with your fitness in the next 30 days?
What do you want to accomplish with your fitness in the next 12 months?
On a scale of 1-10, how committed are you to hitting your goals?
What do you think are the 1-2 most important ways we can help you as your coach? Feel free to elaborate if needed (e.g. accountability, technique help, encouragement, etc)

TRAINING HISTORY

What is your experience with functional training, including barbells, kettlebells, and bodyweight training?
What other training modalities have you participated in? Yoga, running, cycling, CrossFit, etc.
What did you like/dislike about your previous routines?
What types of programs or routines have you been successful with in the past?
What obstacles have you faced in the past, in regards to your fitness routines, that you have struggled with?

ATHLETIC HISTORY

What sports or other physical activities have you participated in? At what age and level?

INJURY HISTORY

Are you currently experiencing pain due to injury or other medical conditions? If yes, please elaborate as much as possible.
Have you experienced any major injuries in the past? Do they still impact you in any way? If yes, please elaborate as much as possible.
Are there any limitations to your movement or otherwise that we should be aware of? If yes, please elaborate as much as possible.

LIFESTYLE FACTORS

Nutrition*
How satisfied are you with your nutrition habits?
Sleep*
How satisfied are you with the quality and consistency of your sleep?
Stress Management*
How satisfied are you with your ability to manage stress?
Social Support*
How satisfied are you with the support you receive from friends and family as it relates to your health and fitness?
This field is for validation purposes and should be left unchanged.