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Fitness Client Intake Form
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Client Name
Your answer
Birth Date
Your answer
Address
Your answer
Employer
Your answer
Emergency Contact Name
Your answer
Emergency Contact Number
Your answer
Please state if you have current/previous health diseases/issues.
Your answer
Please state if you're currently taking any medications.
Your answer
How would you rate your nutrition?
Poor
0
1
2
3
4
5
Excellent
Clear selection
At which frequency do you eat at breakfast?
Never
0
1
2
3
4
5
Always
Clear selection
Please select the reasons you eat (besides hunger).
Stress
Depression
Boredom
Happiness
Habit
Annoyance
Other:
Clear selection
How often can you exercise per week?
Your answer
Please select the best times you can exercise
Early Mornings
Mornings
Early Afternoons
Afternoons
Evenings
Clear selection
What are your goals for training?
Development of muscles
Reducing the stress
Losing body fat
Increasing the motivation
Training for an event/specific sports
Other:
Clear selection
Please add any other information you think would be helpful for me to know to help you achieve your goals.
Your answer
Submit
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