STEP ONE: Name * First Name Last Name Pronouns Age Email * Phone Number Preferred form of Contact Phone Call Email Zoom How did you hear about my services? * Personal Referral Live/work locally Google/Search Engine Yelp Instagram Other Interested Services (check all that apply): * In person Training Online/Remote Training Mobility Training and Joint Improvement Strength Training Body Recomposition Sport Specific Training Nutritional Guidance Injury Prevention & Exercise Technique Preferred Workout Days (check all that apply): * Monday Tuesday Wednesday Thursday Friday Sunday Preferred Workout Times (check all that apply): * 6am-10am 10am-3pm 3pm-8pm What are your top 3 fitness goals: * Do you have any current or old injuries, health conditions, physical limitations or pain: * (diabetes, back pain, heart disease, ankle sprain, shoulder dislocation, ACL reconstruction, etc) If YES, please list How would you rate your current state of health and wellness: * Scale of 1-5, (1 unhealthy, 5 very healthy) What is your current activity level (check most appropriate answer): * Virtual Workouts Sedentary Group Fitness Class Daily Activities (bike, hike, run, walk) Regular Sport Participation (climbing, surfing, etc.) Yoga and/or Pilates Weight Training/Resistance Training Other How would you rate your stress levels (emotional/mental and physical well being): Scale of 1-5, (1 stress free, 5 very stressed) Please select all Practitioners you are currently working with: * Primary Care Physician Physical Therapist Chripractor Body Worker Orthopedist Nutritionist/Dietician Acupuncturist No Other Practitioners Other List your top 1-3 LIFE goals you would like to focus on These can either be fitness or non fitness related Questions or comments? Thank you for taking the time to share your information! Please select “SUBMIT” below to ensure that we receive your New Client Intake Form. Upon submission you will be redirected in order to schedule your 15 minute free phone consultation and continue with the intake process. I am excited to connect with you and continue taking steps towards your goals. Please do not hesitate to reach out with any questions and I will be in touch soon! Congratulations !