Alameda Fitness & Spa

Personal Training Intake

Help your trainer build a safe, effective program tailored to your goals.

Important Disclaimer

This questionnaire is for general fitness screening and program planning only. It is not medical advice, diagnosis, or treatment. Please consult a qualified healthcare professional before beginning a new exercise program, especially if you have a medical condition, injury, concerning symptoms, are pregnant, or have been advised to limit physical activity. Stop exercising and seek appropriate medical help if you experience chest pain, faintness, severe shortness of breath, or unusual discomfort. Personal information should be kept confidential and stored securely.

1. Full name

2. Home address

3. What is your age range?

4. How do you describe your gender?

Optional

5. What is your primary fitness goal?

6. When would you like to achieve your main goal?

7. How would you describe your current activity level?

8. How many days per week can you realistically exercise?

9. How much time can you normally spend on each workout?

10. Has a healthcare professional diagnosed you with a condition that could affect exercise?

11. Do you currently experience any of the following?

Select all that apply.

12. Do you have any current or previous injuries, surgeries, joint problems, or recurring pain?

13. Are you taking medication or receiving treatment that may affect exercise?

If yes, describe any exercise-related instructions from your healthcare professional:

14. How would you describe your usual sleep, nutrition, and stress?

Sleep

Nutrition

Stress

15. What type of support would help you stay consistent?

Select all that apply.

Client Acknowledgment

I confirm that the information provided is accurate to the best of my knowledge. I understand that this questionnaire does not replace medical clearance and that I am responsible for consulting a healthcare professional when appropriate.

Client signature

Date

I acknowledge the disclaimer above