Personal Training Intake Form

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* 1. What type of injury do you have?

Spine

Shoulders

Hips

Knees

Multiple Injuries

No Injuries

Other (please specify)

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* 2. Please describe your injury in detail.

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* 3. Have you had any previous training experience? Select all that apply.

Personal Training

Physical Therapy

Group Classes

Self-Guided Workouts

None

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* 4. What are your fitness goals?

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* 5. Are you willing to invest $150-$300 per month on your health and wellness?

Yes

No

Maybe

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* 6. Do you have any specific concerns or requirements for your training?

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* 7. How did you hear about our personal training services?

Referral

Online Search

Social Media

Advertisement

Other

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* 8. What is your name?

First name

Last name

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* 9. What is your email address?

Email address

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* 10. What is your phone number?

Country Code

Phone number

Ext.