Client Intake Form Name * First Name Last Name Date of Birth * MM DD YYYY Phone * (###) ### #### Email * Emergency Contact * Please list the name and phone number of the emergency contact. Do you have any current injuries or limitations? * Do you have any chronic conditions? * Are you currently under a physician’s care? * Do you take any medications that may affect exercise? * Have you had surgery in the last year? * Occupation & typical daily activity level * Average hours of sleep per night * >5 5-6 7-8 9+ Current stress levels * Low Moderate High Current exercise routine * What are your top 3 fitness goals? * Why are these goals important to you right now? * Have you worked with a trainer before? * Yes No Preferred training frequency * 1x/week 2x/week 3x+/week Training style preferences * Please check all that apply. Strength / Hypertrophy HIIT / Cardio Mobility Other Liability Waiver * I acknowledge that I have consulted my physician and understand the risks of exercise. I release Seth Oliver Fitness from liability. Thank you!
