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?

Fitness Profile

Have you ever trained in a gym or with a fitness trainer before?
What are your fitness goals? (Choose all that apply)
Are you currently dieting?
Do you prepare your own meals?
Are you married?
Do you have children?

JANINA'S

Fitness Center

949-973-0051

1124 Fern Avenue, Brea, CA  92821

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