Fit By Janine — New Client Intake

01

About you

Full name

Date of birth

Occupation

Email

Phone

Emergency contact

Emergency phone

02

Coaching interest

What type of coaching are you interested in?

Online coaching Customized workout plan In person training Not sure yet

03

Your goals

What are your primary fitness goals?

Build strength Build muscle / tone Lose body fat Improve endurance Improve mobility / flexibility Improve overall health / energy Feel more confident Other

What is the #1 thing you'd like to accomplish through personal training?

Do you have a specific event, deadline, or goal you're working toward?

04

Health & wellness

Has a doctor or healthcare professional told you that you have a medical condition that may affect your ability to exercise?

No Yes

Are you currently taking any medications?

No Yes

Do you currently have any injuries, pain, or physical limitations?

No Yes

Have you had any recent surgeries or significant injuries?

No Yes

Is there anything else about your health or physical well-being you'd like Janine to know?

05

Your fitness routine

How often do you currently exercise?

Rarely / not currently 1–2 days per week 3–4 days per week 5+ days per week

What types of exercise do you currently do?

How would you describe your current fitness experience?

Beginner Intermediate Advanced

What workouts or exercises do you enjoy?

Any exercises or types of training you dislike or prefer to avoid?

Average daily steps

06

Lifestyle

Average sleep per night

Less than 5 hours 5–6 hours 7–8 hours 9+ hours

Current stress level

Low Moderate High

Current nutrition habits

Very consistent Mostly consistent Inconsistent Not currently focused on nutrition

Anything you'd like support with regarding your lifestyle or nutrition habits?

07

Your training experience

What would make personal training feel successful for you?

What motivates you most?

Anything you want Janine to know so she can make your training experience comfortable and enjoyable?

08

Client acknowledgment

I understand that personal training involves physical activity and that I am responsible for communicating any pain, discomfort, injury, illness, or changes in my health to my trainer. I understand that personal training is not a substitute for medical diagnosis, treatment, or advice from a qualified healthcare professional.

Client name

Date

Signature

Sign with your finger or mouse

I have read and agree to the acknowledgment above.

New client intake

About you

Coaching interest

Your goals

Health & wellness

Your fitness routine

Lifestyle

Your training experience

Client acknowledgment

You're all set