Intake Form — Cara Conway Personal Training

Name

First Name

Last Name

Phone

(###)

###

####

Date of Birth

YYYY

Gender

Current Weight (lbs)

What is your primary fitness goal?

Please elaborate on your primary fitness goal.

Example: I want to... fit into my favorite pair of jeans, feel strong doing my daily activities, play with my children, or invest in my future self. Whatever your goals may be, please share them below.

WHY do you want to achieve this goal for yourself?

What would it mean to you if you achieved this?

What is preventing you from reaching your goals?

How familiar are you with resistance training?

How many days per week do you want to resistance train?

What other forms of exercise activity do you plan to do weekly?

Please be specific and list/describe all the other physical activities (other than resistance training) you plan to do throughout the week. (This could be hiking 5 miles 2x/wk, 4 hours of yard work every week, HIIT classes with your BF every Saturday) I want to make sure your training allows time to recover.

Do you have any past/current injuries I should be aware of?

If yes, what movements/exercises do they impact? Please be as detailed as possible.

On a scale of 1-10, please rate your diet (1 = poor, 5 = decent, 10 = excellent)

On a scale of 1-10, please rate your quality of sleep (1 = poor, 5 = decent, 10 = excellent)

On a scale of 1-10, please rate your average daily stress level (1 = high, 5 = moderate, 10 = low)

On a scale of 1-10, please rate your commitment to achieving your health and fitness goals. 1 = I never want to leave my couch, 10 = I will do whatever it takes to accomplish my goals.

Please list all additional equipment you have access to if it's not listed above.

What are your favorite exercises?

It's okay if you don't have any!

What are your least favorite exercises?

This isn't to say they won't be in your program, but if we can avoid a particular exercise that you loathe, I will choose an alternative.

Do you have any questions?

Do you prefer to hear back via email or a phone call?

Whichever you prefer, we'll go over your questions and discuss how to get started. Plan 5-15 mins for phone calls.

Phone Call

Thank you so much for taking the time to fill out my intake form! I will contact you within 24-72 hours and review everything you need to start your Online resistance training journey!