Personal Training/Health Coaching Intake
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Name *
Date of Birth *
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DD
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Email *
Do you exercise now? *
If you answered no to the above, when was the last time you held a steady exercise routine?
If you have an exercise routine, what type of activities do you do? *
Do you have a specific goal you are looking to attain (first 5K, marathon. keep up with kids/grandkids, overall health...) *
Any physical restrictions? *
How would you describe your current state of health? *
What are your honest feelings about exercise/physical activity?  
 *
  What are some of your favorite physical activities?  
 *
Any current medications? 
Any medical condition (heart disease, diabetes, asthma...) *
Are you looking for nutrition/lifestyle support as well? *
What Day(s) are you looking to train? *
What time of the day works best with your schedule? *
How would you like us to contact you
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If you would like us to contact you by phone, what works best?
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Please provide your phone number if you want to be contacted by phone.
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