Personalized Training Program Intake Form 
Please fill out the below form if you are interested in a 4-week personalized training program that includes unique exercises for your specific goals, recommended weight selections and weekly check-ins.
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First & Last Name
Email Address
Phone Number
Have you worked with a personal trainer previously?
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How would you rate your current fitness level (1 = Unfit / 10 = Very fit)
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What exercise activities do you currently take part in (e.g., running, weightlifting, group exercise, etc.)?
What type of equipment have you used?
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Are you comfortable performing the main compound lifts (Deadlift, Squat, and Bench Press)?

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Is there anything in your current training you have felt to be particularly beneficial?
Is there anything in your current training you have felt to be NOT particularly beneficial?
How many days per week do you get at least 45 minutes of exercise?
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Realistically how many days per week can you dedicate to training?
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Realistically how much time can you devote to each exercise session?
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Do you partake in any recreational physical activities? (If YES, please explain.)
Do you have any chronic health conditions (such as, but not limited to, cardiovascular disease, pulmonary disorders, hypertension, diabetes, or cancer)? (If YES, please explain.)
Are there any exercises you are unable to perform due to injury?
What are your primary area(s) of interest?
What would your perfect fitness program look like?
Please list your specific fitness goals you would like to achieve. (Think short term and long term)
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