Client Intake Form Before completing the client intake form below, please read and agree to our Client Consent terms. Client Information Name * First Name Last Name Email * Phone * (###) ### #### Address * Birthday * MM DD YYYY Height * Weight * Health Questionnaire How do you rate your fitness on a scale of 1-10? * How many days a week are you currently exercising? * What areas of your personal fitness would you like to improve? * What are your fitness goals? * How motivated are you to reach your fitness goals? * How do you rate your current health on a scale of 1-10? * How many times a day are you eating? * How many snacks do you have during the day? * Do you drink alcohol? * Moderately, frequently, or not at all How important is your health on a scale of 1-10? * What are the health goals you are trying to reach? * Do you have any injuries? * Do you have any health concerns? * Like Diabetes, High Blood Pressure, Heart Disease, Cancer, Respiratory I agree to the Client Consent terms * Yes, I agree Thank you!
