TITUS FITNESS PERFORMANCEINTAKE FORM Name * First Name Last Name Email * Phone * (###) ### #### Date of Birth * MM DD YYYY How long have you been thinking about training? * What are your current physical goals? * Weight Loss Strength Body Composition Sport Specific Performance Mobility Injury Rehabilitation General Health Other What becomes possible when you achieve this goal? * Please describe the last time you achieved your physical goals. What are your current lifestyle goals? * Increased Energy Increased Mental Clarity Community Improved Relationships Increased Libido Overall Happiness Decreased Stress Improved Sleep Nutrition Please explain how reaching this lifestyle goal will impact your life. Please describe your athletic/physical history? What are you looking for from me as a trainer? * Expertise Motivation Accountability Time Efficiency Other How many days a week would you ideally like to train? * 1-2 3-4 5-7 How would you rate your current fitness level? * 01 - Novice 02 03 04 05 06 07 08 09 10 - Spartan Have you ever worked with a trainer prior to now? * Yes No If yes, please describe your experience. Are there any specific exercises that you are uncomfortable performing? * Are there any specific exercises that you enjoy performing? * How would you rate your confidence in this training experience? * 01 - Blah 02 03 04 05 - It's going to be awesome! Please explain any apprehensions you may have or what you are most excited about. * If you plan on working out at home, please list your available equipment in detail. Please include type of equipment, weight, brands and if you have bands, the colors you have. Thank you! I truly appreciate your business. I am dedicated to helping you achieve what you set out to do.
