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JANINA'S Fitness Center

949-973-0051

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- New Client Intake Form
One-on-One

Personal Training Intake Form

I shall work very hard with you to help you meet your fitness goals! Your health and fitness are very important to me.

I’m your dedicated trainer and am here to help you meet and achieve all your fitness goals. This intake form is the first step of your personalized fitness plan.

Contact Information

Medical History

Have you ever been involved in a car accident that’s caused back injury or other type of injury? *

YES

NO

Fitness Profile

Have you ever trained in a gym or with a fitness trainer before? *

YES

NO

What are your fitness goals? (Choose all that apply)

Shape Up

Lose weight

Lose inches

Are you currently dieting? *

YES

NO

Do you prepare your own meals? *

YES

NO

Are you married? *

YES

NO

Do you have children? *

YES

NO

JANINA'S

Fitness Center

949-973-0051

1124 Fern Avenue

Brea, CA 92821

Contact JANINA

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