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Personal Training Client Intake Form

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  3. Personal Training Client Intake Form

Personal Training Intake Form

2020 Intake form for Personal Training Clients

Step 1 of 12

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  • 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.
  • *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

  • 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

  • I hereby authorize Body First to provide personal training services for my minor child or dependent.
  • 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.
  • You and Body First

  • You and Fitness

  • Hidden
  • Your Goals

    In order to increase the chances of reaching your goals and feeling succesful, we strive to ensure you goals are "SMART"
  • S=Specific
    M=Measurable
    A=Attainable
    R=Reward-based (attach a reward to each goal)
    T=Time (set specific dates for goals

    Mark all that apply
  • Lower blood pressure, improve cardiovascular health, etc
  • faster 10K, bench press max, train for military fitness tests etc.
  • Weight Loss, build muscle, etc
  • Lifestyle Related

    Your lifestyle impacts your health and also can be a determining factor in your success in regard to your personal fitness. At Body First, we strive to provide evidence-based training and guide you in ways to make your fitness journey a successful one.
  • Computer work, heaving lifting, lots of driving, on you feet all day etc.
  • 3-5 times/day, 1 time per day, weekends only, less than once a month, etc.
  • Health History

    Though we are not required to by law, it is the intention of Body First to ensure the confidentiality and integrity of protected health information of both clients, members, and employees as required by HIPAA, professional ethics, licensure requirements, and any other legal requirements. At this time our website has a SSL Certificate, is PCI compliant, and have we enacted numerous protocols to protect your data and we do not store any personal health information in our database. At this time we have taken the numerous steps to ensure your information is safe and secure we are still working integrating our website to be HIPAA compliant. If you do not wish to answer any of the following questions online, we will collect this information at the time of your appointment.
    Please mark all conditions that apply
  • We STRONGLY RECOMMEND that if you marked any existing condtions above that you consult with your doctor before beginning any exercise program.

  • 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.
  • TRAINING PREFERENCES

  • 2 times per week, once a week, every other week, monthly, etc.
  • 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
  • *
  • Body First Policy Privacy
  • *
  • Body First Cancellation and Scheduling Policies
  • *
    I understand that the personal training services I receive are provided for the purpose of exercise instruction and guidance.
  • *
    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.
  • *
    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.
  • *
    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.
  • *
    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.
  • *
    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.
  • 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.
  • 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.
  • *
    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/
  • This field is for validation purposes and should be left unchanged.

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