Intake Form - PT — Naturally Guided Health

Personal Training

Please complete the form below. Upon receipt, we’ll follow up with you to talk about your goals, needs, and schedule.

Name

First Name

Last Name

Email

Cellphone

(###)

###

####

Date of birth

MM

DD

YYYY

What are your goals for personal training with me?

Are there any limitations or injuries I should be aware of?

Any medical history I should be aware of?

(i.e. blood pressure issues, asthma, surgeries, etc.)

Do you have a way to monitor heart rate while exercising?

Yes

No

How many days a week are you interested in training?

Have you ever used free weights?

Yes

No

Do you have any workout equipment at home?

If yes, please list here.

Anything else you want me to know?