Personal Training Client Intake Form

Personal Training Intake Form

2020 Intake form for Personal Training Clients

Step 1 of 12

Physical Activity Readiness (PAR-Q)
If you haven't been active recently, or are looking to add a new or more intense exercise to your current routine, the physical activity readiness questionnaire (PAR-Q) can help you decide if you are ready to exercise safely, or if you might need a trip to your physician to make sure you don't push beyond your own limit.
Please mark the conditions you are experiencing or have in the past.*
- Your doctor has said that you have a heart condition and you should only do exercise recommended by a doctor
- You feel pain in your chest when you do physical activity
- You have had chest pain in the last month when you did physical activity.
- You lose your balance because of dizziness or you have lost consciousness.
- You have a bone or joint problem (for example, back, knee or hip) that could be made worse by a change in your physical activity
- Your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition
- you know of any other reason why you should not do physical activity
- none of the above
Clearance to workout*
I have been cleared by doctor to begin exercise or do not have any of the conditions above.
*NOTE: If you answered “yes” to one or more conditions above, please speak with your doctor by phone or in-person BEFORE you become more physically active or BEFORE you begin personal training and fitness testing. Please tell your doctor which questions you answered “yes” to and discuss possible exercise restrictions. Your safety when becoming more physically active is our main concern. IF YOU ARE PREGNANT OR YOUR HEALTH CHANGES PRIOR TO EXERCISING SO THAT YOU ANSWER “YES” TO ANY OF THE ABOVE QUESTIONS, WE STRONGLY RECOMMEND YOU SPEAK TO YOUR DOCTOR BEFORE MEETING WITH A BODY FIRST PERSONAL TRAINER!

Contact Information
Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Cell Phone*
Secondary Phone#*
Date of Birth*
Month
Day
Year
Are you (the client) over the age of 18*
- YES
- NO
If the client is 14 years or younger or special needs please contact Body First so we can make the appropriate accommodations

All minors age 17 and younger are required to have parent consent
Consent for personal training for a minor*
Consent for personal training for a minor
I hereby authorize Body First to provide personal training services for my minor child or dependent.
Parent/Guardian Name
First Last
Emergency Contact*
Emergancy Contact Phone #*
EMAIL
Body First utilizes your email to send email appointment notifications, email reminders, and to contact you when we are unable to contact by other means. Please choose to OPT-IN if you want to receive news, updates, and specials from Body First.
Email*
EMAIL OPT-IN: Body First Wellness
I would like to receive email wellness news and updates from Body First.
EMAIL OPT-IN: Body First Strong
I would like to receive fitness specific news and updates from Body First.
EMAIL OPT-IN: Body First Tennis
I would like to receive tennis specific news and updates from Body First.

Devoloping your fitness program
Help us provide you with a positive personal training experience. Please take the time to let us know what you are starting and what you would like to achieve.
What have you been doing for fitness for the 30-60 days.
What were you doing at the time to be in the best shape of you life? and when was that?
What is currently missing from your routine?

TRAINING PREFERENCES
Have you trained with personal trainer before?*
Yes
No
If yes, How often did you train?*

2 times per week, once a week, every other week, monthly, etc.

List any additional conditons not listed

Please explain of the conditions listed above.

Your Agreement to Services
Please take a moment to read and agree the following statements regarding your treatment. By checking the boxes your are hereby affirming that you have read, fully understand and therefore consent to participating with Body First in programs and services within the framework stated below and in Body First's Privacy Policy
Privacy Policy*
I agree to the privacy policy.*
Body First Policy Privacy
Scheduling and Cancellation Policies*
I agree to the Scheduling and Cancellation Policies.*
Body First Cancellation and Scheduling Policies
Personal Training for exercise and guidance.*
Personal Training for wellness*
I understand that the personal training services I receive are provided for the purpose of exercise instruction and guidance.
Client Health Warranty*
Client Health Warranty*
I am not aware of any disability, impairment, or ailment preventing me from participating in personal training. I affirm that I have stated all my known medical conditions and injuries and answered all questions honestly. I agree to keep the personal traineres updated as to any changes in my health profile, and understand that there shall not be liability on the massage therapist’s part should I forget to do so. Furthermore I recognize that personal training may involve strenuous physical activity including, but not limited to, muscle strength and endurance training, cardiovascular conditioning and training, and other various fitness activities. I hereby affirm that I am in good physical condition and do not suffer from any know disability or condition, which would prevent or limit my participation in this exercise program.
Personal Trainer role in client wellness.*
Perosonal Trainer role in client wellness.*
I understand that personal trainers are not qualified to diagnose or prescribe for disease conditions and that nothing said, done, performed, typed, printed or produced is intended or meant to diagnose, prescribe, treat a disease or takes the place of a licensed physician, chiropractor, registered dietitian or other qualified health professional. I understand that body maintenance assessments and suggestions are intended only for the support of optimal health and do not involve diagnosing, prognosticating or prescribing any remedies for the treatment of disease conditions.
Client's Responsibility for their wellness*
Client's Responsibility for their wellness*
I understand that I accept total responsibility for my own health care and maintenance and that I should seek treatment from a physician, chiropractor, registered dietitian or other qualified medical specialist for any medical conditions that I am aware of.
Trainer or coach's right to refuse service.*
Trainer or coach's right to refuse service.*
I understand that the trainer or coach may choose to end any session if they believe continueing could be detrimental to the client, the client is under the influence of drugs or alcohol, or the client exhibits any inappropriate behavior towards the trainer or coach.
Client's Right to manage their personal training session*
Client's Right to manage their personal training session*
If I experience any pain or discomfort it is my responsibility for my own health, physical well being, and maintenance to inform the trainer/coach so they can adjust the program/session and help avoid injury.
Release of liability
Release of Liability
In consideration of my participation in this program, I hereby release Body First LLC and/or Body First Staff from any claims, demands, and causes of action as a result of my voluntary participation and enrollment of the provided personal training services and/or exercise classes. I fully understand that I may injure myself as a result of my enrollment and subsequent participation in this program, and I hereby release Body First or their employees, staff, or subcontractors from any liability now or in the future for conditions that I may obtain. These conditions may include, but are not limited to, heart attacks, muscle strains, muscle pulls, muscle tears, broken bones, shin splints, heat prostration, injuries to knees, injuries to back, injuries to foot, or any other illness or soreness that I may incur, including death.
Consent of services of Minor

Minors 14 and under and special needs clients: – Please inform Body First if the minor child is under age 15 so we can make accommodations for the parent/guardian to accompany the child.

Updates to Policies in regards to COVID-19*
I understand there are changes to Body First operations and policies relating to COVID-19 and Body First reserves the right to change their policies as time this situation progresses.*
As Body First re-opens Body First, we have updated many of our operating procedures and policies to reflect the changes we have made in light of the COVID-19 Pandemic.
https://bodyfirst.com/update-to-body-first-operations-and-policies-covid-19/
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Personal Training Intake Form

Step 1 of 12

Physical Activity Readiness (PAR-Q)

Contact Information

EMAIL

You and Body First

You and Fitness

Your Goals

Lifestyle Related

Health History

Devoloping your fitness program

TRAINING PREFERENCES

Your Agreement to Services