Epicurves
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Client Registration
Epicurves Personal Training Client Intake Form
Name
Date of Birth
*
Gender
*
Male
Female
Phone
*
Email Address
Fitness Goals
What are your primary fitness goals?
*
Weight Loss
Muscle Gain
Toning & Shaping
Improved Flexibility
General Fitness
Other (please specify)
Any Other Fitness Goal (Please Specify)
Target Areas (if any)
Chest
Arms
Legs
Hips & Glutes
Core
Full Body
Other (please specify)
Target Areas (if any)
What motivated you to seek personal training?
What do you hope to achieve in the next 3-6 months?
Fitness History
Have you worked with a personal trainer before?
*
Yes
No
What kind of exercise have you done in the past?
Cardio
Strength Training
Yoga/Pilates
Sports
None
Select your current fitness level
Beginner
Intermediate
Advance
How often do you currently exercise?
*
Never
1-2 times per week
3-4 times per week
5+ times per week
Health & Medical History
Do you have any medical conditions that we should be aware of?
*
Yes
No
If yes, please explain:
Any past injuries or surgeries?
*
Yes
No
If yes, please specify
Do you have any physical limitations or chronic pain?
*
Yes
No
If yes, please describe
Are you currently on any medication that may affect your training?
Yes
No
If yes, please list
Lifestyle & Preferences
Occupation (to understand physical activity level):
*
How many hours a day do you typically spend sitting?
Less than 4 hours
4 – 6 hours
6 – 8 hours
More than 8 hours
How much sleep do you get on average per night?
Less than 6 hours
6 – 8 hours
More than 8 hours
Do you have any dietary restrictions or preferences?
Yes
No
If yes, please explain
Physical Assessment (To Be Done During the Session)
Height
Weight
Initial Movement Screening Results (Squats, Lunges, etc.):
Flexibility & Range of Motion Observations:
Training Preferences
How many days per week would you like to train?
1 – 2 days
3 – 4 days
5+ days
What time of day do you prefer for your sessions?
Morning
Afternoon
Evening
Additional Notes or Concerns
Agreement & Signature
By signing this form, I confirm that the above information is accurate to the best of my knowledge, and I understand that all fitness activities are undertaken at my own risk.
Client Signature
Date
Register
