Intake Form

Name *

Gender *

Female

Male

Prefer not to say

Other:

Age *

Your fitness or health goal *

Please add how you would like to be contacted -Phone number or email address

Health history/ limitations that would affect physical activity *

What has held you back from reaching your goal? *

What kind of assistance would you be looking for to help you achieve your health and fitness goals. *

Have you ever worked with a trainer?