HELP US GET TO KNOW YOU

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This form allows us to get to know you, understand your goals and your athletic, training, and injury history in order to coach you as effectively as possible.

First Name *

Last Name *

Phone *

Email *

Date of Birth *

Address *

City *

State *

Postal code *

How did you hear about us? *

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A friend referred me
Google
Instagram
Facebook
Walked/drove by the gym
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Profession *

EMERGENCY CONTACT INFORMATION

Emergency Contact (First Name) *

Emergency Contact (Last Name) *

Emergency Contact (Phone) *

Emergency Contact Relationship *

FITNESS GOALS

Short-Term Fitness Goals (Next 30 Days) *

Long-Term Fitness Goals (Next 12 Months) *

Commitment to Fitness Goals *

On a scale of 1-10, how committed are you to hitting your goals?

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2
3
4
5
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7
8
9
10
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Coach:Client Relationship *

TRAINING AND ATHLETIC HISTORY

Functional Training Experience *

Other Training Experience *

Likes and Dislikes *

Successes *

Challenges *

Sports and Other Physical Activities *

INJURY HISTORY

Current Injury and/or Pain *

Previous Injury and/or Pain *

Movement Restrictions or Limitations *

LIFESTYLE FACTORS

Nutrition *

Very Satisfied

Satisfied

Neutral

Unsatisfied

Very Unsatisfied

How satisfied are you with your current nutrition habits?

Sleep *

Very Satisfied

Satisfied

Neutral

Unsatisfied

Very Unsatisfied

How satisfied are you with the quality and consistency of your sleep?

Stress Management *

Very Satisfied

Satisfied

Neutral

Unsatisfied

Very Unsatisfied

How satisfied are you with your ability to manage stress?

Social Support *

Very Satisfied

Satisfied

Neutral

Unsatisfied

Very Unsatisfied

How satisfied are you with the support you receive from friends and family as it relates to your health and fitness?