VERDE ORGANIC BODY

TRAINING INTAKE FORM

First name

Last name

Birthday

Month

Day

Year

Preferred Pronouns

He/Him

She/Her

They/Them

Other

Occupation

HEALTH/MEDICAL INFORMATION

Current height

Current weight (estimate)

List previous injuries (with date)

List previous surgeries (with date)

List any known physical limitations

List any known health conditions

List any medications and/or supplements

WELLNESS ASSESSMENT

How would you describe your activity level?

Very Active

Somewhat Active

Not Active

How would you describe your confidence level in the gym?

Very Confident

Somewhat Confident

Not Confident

How would you rate your Eating Habits?

Very Healthy

Somewhat Healthy

Not Healthy

How much water do you drink in a day (estimate)?

TRAINING PROGRAM AND GOALS ASSESSMENT

Have you ever had a personal trainer or done open gym sessions before? If so, what did you like or dislike about it?

List your specific goals for starting a training trogram

Do you have a specific weight goal for training?

Lose Weight (Decrease Fat)

Maintain Weight

Gain Weight (Increase Muscle)

If you have a specific weight goal, what is your target/ideal weight goal?

How many days a week are you able/willing to devote to Training?

Whats your biggest struggle or challenge with your current fitness routine or when trying to reach your goals?

What are the 3 main things you look for in a training program?

What do you want to accomplish in the next 3-6 months with a training program?

How will you know when you have reached your graining goals?

When, or what date would you like to reach your goals or see results by?

Is there anything else you would like us to know in regard to your training program sessions with us?

Is there anything specific you are looking for in your wellness journey that you would like to share?