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new client intake form

Please fill out the form below providing as much detail as possible to allow me to best tailor your plan to your goals and needs

Gender

Health Questions

Did you ever suffer from any of the following:

Has your doctor ever said you have a heart condition and that you should only do physical activity recommended by the doctor?
Do you feel pain in your chest when you do physical activity?
In the past month have you had a chest pain when you were not doing physical activity?
Do you lose your balance because of dizziness or do you ever lose consciousness?
Do 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?
Is your doctor currently prescribing medication for your blood pressure or heart condition?
Is your doctor currently prescribing medication for your blood pressure or other heart condition?
Do you know of any other reasons why you should not do physical activity?
Are you pregnant?
Have you been in the hospital in the last 3 years?
Do you suffer from asthma or breathing difficulties?
Do you suffer from allergies?
Did you ever have surgery?
Are you taking any over the counter and/or prescription medication?

Personal exercise history questionnaire

Pease send me front, side and back photos to my WhatsApp. Please follow the check-in photo etiquette. Photos/weight-ins should be taken after waking up, on an empty stomach, preferably in the same lighting conditions.

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Female photos must be in a bikini, no thongs, or sports shorts and sports bra.

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Male photos need to be in boxers.

Thanks for submitting!

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