New Client Intake Form

First + Last name

Email

Phone

What kind of services are you looking for?

Group Fitness Classes

Personal Training

Movement Specific Training for Dancers + Martial Artists

Nutrition + Health Coaching

Applied neurology for pain management, injury rehabilitation, joint re-education improved posture, healthy aging

Other

Multi choice

Beginner (mostly sedentary and/or new to fitness)

Recreational Exerciser (works out a couple of days a week)

Active and In-Shape (room for refinement)

Advanced (experienced and/or competitive athlete/mover)

Elite/Professional

Briefly describe your athletic/movement background

List any past injuries ( examples: broken bones, ruptured joints, dental work, surgeries, repeated muscle pulls, rolled ankles, concussions etc)

Medical Conditions (Include examples like: do you wear/use glasses, hearing aids, pacemakers or any other devices?)

What are your current goals?

Anything else you'd like me to know?