New Client Intake Form

Personal Information:

Name(Required)

Age(Required)

Gender(Required)

Male

Female

Rather not say

Current body weight (kgs)

Email(Required)

Contact number(Required)

Address(Required)

Street Address Address Line 2 City Postcode

Emergency contact name(Required)

Emergency contact phone number(Required)

Fitness and Health History

How would you describe your current fitness level?

Have you participated in personal training or fitness programs before?(Required)

Yes, I have

No, I haven't

Please provide details of any previous personal training or fitness programs

Do you have any past injuries or health conditions that may impact your ability to engage in physical activity?(Required)

Yes, I do

No, I don't

Please provide details of any any past injuries or health conditions

Nutrition Information

Do you have any dietary restrictions or allergies?(Required)

Yes, I do

No, I don't

Please specify any dietary restrictions or allergies

Please describe your current daily food intake, including meals and snacks.(Required)

Fitness Goals

What are your primary fitness goals?(Required)

e.g. Are there specific areas of your body you would like to focus on or improve?

Lifestyle and Schedule

What is your occupation?(Required)

How would you describe your typical daily activity level?(Required)

Please indicate your availability for training sessions (days and times).(Required)

Additional Information

How did you hear about our personal training and nutrition services?(Required)

Internet search

Recommendation from another person

Something else

Can you tell us more?

Is there anything else you would like us to know before we begin working together?

Personal Information:

Fitness and Health History

Nutrition Information

Fitness Goals

Lifestyle and Schedule

Additional Information

Whitby, Porirua 5024

info@healthytomorrow.co.nz

021 1457 009