Intake Form Please enable JavaScript in your browser to complete this form.Name *FirstLastPhone Number *Email *Date Of Birth *Gender *Height *Weight *What do you do for a living? *Do you exercise regularly? *YesNoI used to Please list the physical activities that you participate in outside of the gym and outside of work.: *Are you a current smoker? *YesNoWhat following goals does best fit in with your goals? *Improved HealthImproved EnduranceIncreased StrengthIncreased Muscle MassFat LossHow often are you willing to train a week to reach your goal? *Do you have any existing injuries or conditions that I should be aware of while building your training plan?At what times during the day would you prefer to train? *MorningMiddayAfternoonEveningWhat days of the week are you available to work out? *What are your expectations on me as your Personal Trainer? *EmailSubmit