New Client Onboarding

CLIENT INTAKE & CONSULTATION FORM

This form is strictly confidential. The information you provide will be used solely to design a safe, effective, and personalized training program. Please answer all questions as honestly and thoroughly as possible.

Coach: Stefan | NASM-CPT
Email: [email protected]
Phone: (213) 907-4122
1

Personal Information

Emergency Contact

2

Goals & Motivation

3

PAR-Q+ Physical Activity Readiness Questionnaire

Please answer YES or NO to the following questions. If you answer YES to any question, you must consult a physician before beginning an exercise program.

Has your doctor ever said that you have a heart condition OR high blood pressure?

Do you feel pain in your chest at rest, during your daily activities of living, OR when you do physical activity?

Do you lose balance because of dizziness OR have you lost consciousness in the last 12 months?

Have you ever been diagnosed with another chronic medical condition (other than heart disease or high blood pressure)?

Are you currently taking prescribed medications for a chronic medical condition?

Do you currently have (or have had within the past 12 months) a bone, joint, or soft-tissue problem that could be made worse by becoming more physically active?

Has your doctor ever said that you should only do medically supervised physical activity?

4

Medical & Injury History

Do you have any current injuries or pain?

Do you have any significant past injuries?

Have you had any surgeries?

Do you have any diagnosed medical conditions?

Are you currently taking any medications?

5

Current Fitness Level & Exercise History

6

Nutrition & Lifestyle

7

Sleep & Stress

8

Training Logistics

9

Liability Waiver & Informed Consent

I, the undersigned, acknowledge that I am voluntarily participating in a personal training program designed and supervised by Stefan, NASM-Certified Personal Trainer ("Coach").

I understand that physical exercise involves inherent risks, including but not limited to: cardiovascular events, musculoskeletal injuries, and other health complications. I confirm that I have truthfully completed this intake form and disclosed all relevant medical history.

I agree to inform my Coach immediately of any pain, discomfort, or unusual symptoms during training. I release the Coach from any liability for injuries sustained during training, provided the Coach has acted within reasonable professional standards.

I confirm that I have been advised to consult a physician before beginning this program if I answered "Yes" to any PAR-Q+ question, and I have done so or accept full responsibility for proceeding without physician clearance.

By signing below, I confirm that I have read, understood, and agree to all terms of this waiver and consent form.

10

Anything Else?

* Required fields. All information is kept strictly confidential.