PT Client Intake Form

By filling out this intake form, you’ll provide me with all the details I need to design a personalized training program just for you. Your answers will help me understand your goals, preferences, and any specific needs or limitations you might have. Once I have everything, I’ll get back to you to share the next steps and how we can start this journey together.

Thank you for trusting me with your training—I’m looking forward to supporting you every step of the way!

Warmly,

Ana

Nom

First Name

Last Name

E-mail

Téléphone

(###)

###

####

Adresse

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Age

Height

Weight

Body Fat Percentage Estimation

If known

Years of training experience

Bench Press Strength

State your current maximum abilities in weight times reps.

Barbell Squat Strength

State your current maximum abilities in weight times reps.

Chin Up Strength

State your current maximum abilities in weight times reps only with the external weight (exclude body weight).

Overhead Press Strength

State your current maximum abilities in weight times reps.

What are your fitness goals?

Do you have any muscle groups you do NOT want to get bigger?

Will you want to perform any other form of exercise alongside strength training?

Which of the following options best describes your dedication level?

A: Sustainability is most important to me. As long as I’m moving in the right direction, I don’t care about the rate of progress.

B: I want to strike a reasonable balance between good results in proportion to effort and sustainability.

C: I will do whatever it takes to achieve maximum results without compromising my health.

How often in a week are you prepared to train for results?

What is your occupation? You may be general here.

The aim is to characterise your circadian rhythm, stress and activity level.

Please list any pathologies and injuries (disabilities, allergies, illnesses, syndromes, disorders etc.) you have or had.

Do you insist on any special diet?

Are there any times at which you are unable or unwilling to train?

This includes when you’re at work. If you insist on training at any specific time, such as in the mornings, please let me know here as well.

Which of the following options best describes your day to day activity level aside from your planned training sessions?

Which of the following options best describes your stress level?

How is your sleep rhythm and quality?

How much caffeine do you consume daily on average or on a typical work day?

[Women only] Do you have a regular menstrual cycle? And are you using any form of contraception?

If these questions are sensitive, feel free to ignore them, but the more information I have, the better I can help you.

Do you have skinfold calipers?

Where do you plan to train?

EQUIPMENT: List all the equipment you have access to AND/OR attach pictures of the equipment in the next field.

EQUIPMENT: What are the lightest barbell weight plates you have access to?

EQUIPMENT: What are the smallest weight increments between the sets of dumbbells you have access to?

GENETICS: Wrist circumference (smallest point):

GENETICS: Ankle circumference (smallest point):

GENETICS: How much did you weigh before you started lifting and what was your height at that point?

GENETICS: Were you heavy as a baby?

Please list all supplements you’re currently taking.

Please describe or attach your current diet plan in detail.

Please describe or attach your current training program in detail.

Anything else you want to tell me.