New clients · Form 1 of 2

Client information & health history

Please complete this as accurately as possible. Everything you share is confidential and is used only to program your sessions safely.

Takes about five minutes. Questions marked * are required — leave anything else blank if it does not apply.

About you

Basic details and who to contact in an emergency.

Name

Birthdate

Address

Phone number

Emergency contact (name & number)

Gender

MaleFemalePrefer not to say

Weight

Height

Your goals

What you want out of training, and where you are starting from.

What do you hope to gain from working with a personal trainer?

How did you hear about us?

What exercise activities do you currently take part in (e.g. running, weightlifting, group exercise)?

How many days per week do you get at least 60 minutes of moderate-intensity exercise?

Nutrition

Are you currently following any kind of diet? If so, what diet and for what reason(s)?

How would you rank your daily salt intake?

LowMediumHigh

How would you rank your daily sugar intake?

LowMediumHigh

How would you rank your daily fat intake?

LowMediumHigh

How many alcoholic drinks do you consume per week?

How many caffeinated beverages do you consume per week?

Sleep & stress

Do you feel like you get enough sleep and wake up feeling rested most days?

YesNo

What techniques do you currently use to manage your stress levels?

Do you smoke tobacco or use a vaporizer alternative?

YesNo

Work & lifestyle

How you spend your day shapes how your body moves.

What is your occupation?

Does your occupation require extended periods of sitting? (If yes, please explain.)

Does your occupation require repetitive movements? (If yes, please explain.)

Does your occupation require you to wear shoes with a heel (e.g. dress shoes, work boots)?

YesNo

Do you take part in any recreational physical activities (golf, skiing, etc.)? (If yes, please explain.)

Do you have any additional hobbies (gardening, fishing, music, etc.)? (If yes, please explain.)

Health history

The more detail here, the safer and better-targeted your programming.

Please list any past musculoskeletal injuries:

Please list any past surgeries:

If you have had injuries or surgeries, were they properly rehabilitated, and did you receive clearance from a doctor to return to physical activity?

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 you on any medications, and if so, have you received clearance from your doctor to take part in physical activity?

Is there anything else we should know about you, or anything you would like to share?