Interested in personal training? Fill out this new client intake form and I will be in touch! Name * First Name Last Name Email * Phone (###) ### #### Birthday Emergency Contact Name * First Name Last Name Emergency Contact Phone (###) ### #### Do you have any existing medical conditions? (heart disease, diabetes, high blood pressure, etc.) Yes No Have you had any recent surgeries or injuries? Yes No Are you currently taking any medications? Yes No Do you have allergies? Yes No Has a doctor ever advised you against exercise? Yes No What are your primary fitness goals? How would you describe your current activity level? Have you ever worked with a personal trainer before? Yes No Do you have any specific exercise preferences or restrictions? Yes No How many days per week do you exercise? What types of exercise do you enjoy? How would you rate your nutrition? Do you have and dietary restrictions or preferences? Is there anything else you would like to add? How did you hear about Kc.Lane Fitness? What are you ideal days and times to train? * Thank you!
