BenjisForm

Complimentary Session Intake Form:

Name:
Best phone number to reach you:
Email Address:
What location would you like training? (please include entire address)
Days you’d like to train: Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
What time would you like to train?
What is the date(s) you’d like your complimentary session? (Please give me 2-3 days and times that will work for you.)
What’s ailing you?
Do you smoke? If so, how much?
Do you have ANY health issues I should know about? This includes but not limited to: high blood pressure, high cholesterol, heart condition, joint, muscle or other injuries. Please include ANY and ALL ailments no matter how small.
Is there any reason exercise may be harmful for you?
If you are male over 45 or female over 55, have you been examined by your doctor within the last 12 months and are FREE and CLEAR to exercise? Yes
No
What are your top 3 goals for hiring me? What do you want to see in 90-days?
What are your biggest fitness challenges?


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