Client Intake Form
Yaaaaaas, friend! Let's do this!

We are officially one step closer to training together and I couldn't be more excited to begin working with you!
For starters, you're in good hands!

I've been poling since September 2014, teaching consistently for two years, hold an active personal trainer certification from NASM, I'm an Xpert certified pole instructor, snagged a First Place win at PSO, and have performed 6 times in 2019 alone.

My areas of expertise include: beginner lessons, competition/performance preparation, choreography development, strength training, and choreography lessons.

Trigger Warning - Weight Loss:
Not everyone's goal with pole is weight loss. In fact, most people I've met are in it simply because they love it! However, if weight loss IS a goal for you, then I can help in that area as well. I have personally lost 40 pounds through poling consistently and a modified diet and would be happy to support you on that journey if that's something that is important to you.

In the last two years, I've grown exponentially as a poler and performer, so I know first-hard what a consistent pole regimen can do for your growth, and I'm grateful and excited about the opportunity to be able to help you get closer to your goals!

I'm a firm believer in establishing goals and creating plans to achieve them. Not only do they hold us accountable, but they make our goals real and give us a path to attain them. That's where this form comes in. Your responses to these questions will help me understand what your goals so that I can develop a formal training plan that helps you achieve them.

So, without further ado, let's get started!


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Name *
Email Address *
Phone Number *
Preferred Communication Method *
Obligatorio
Please list any injuries or health conditions that I should be aware of. Write N/A if not applicable. *
Choose the option that fits you best *
What would you like to focus on in your training (choose all that apply)? Your response will help me craft a formal training plan for you. *
Obligatorio
Based on the selections that you made above, what would you like to focus on in your first training? *
What's your goal? Your response will help me design training that supports your goals. *
How often would you like to train together? Your response is not set in stone, it's just used as a base for your training plan. *
ONLY ANSWER IF YOU HAVE PREVIOUS POLE EXPERIENCE:                                                                         What do you feel your strengths are? (e.g. flexibility, power moves, inverting, climbing, flow, choreography, spin pole, static pole, elbow holds, thigh holds, etc.)
ONLY ANSWER IF YOU HAVE PREVIOUS POLE EXPERIENCE:                                                                        What areas are you hoping to improve in? (e.g. flexibility, power moves, inverting, climbing, flow, choreography, spin pole, static pole, elbow holds, thigh holds, etc.)
Are you comfortable doing any of these moves (Choose all that apply)?
What kind of music do you enjoy dancing to? (choose all that apply)
Are there any specific moves that you would like to work toward? List them all below
Is there anything else that you would like to share about you or your goals?
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