Client Information Form by admin | Sep 28, 2015 | Uncategorized PERSONAL TRAINING CLIENT INFORMATION FORM Step 1 of 2 50% Congratulation for choosing Fit Bella Vie for your personal training! Our goal is to not only help you reach but excel with your fitness and lifestyle goals. The information you provide below aids me in developing the program best suited for your needs. All information provided is confidential.GenderMaleFemaleName First Last Birth Date Address Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email OccupationOccupation typeactivesedentaryHome Phone (optional)Cell Phone*Preferred contact methodCheck all that apply email text call cell call home FromBest time frame to be contacted : HH MM AM PM To : HH MM AM PM HEALTH QUESTIONNAIRE Do you smoke?noyessometimesDo you have any heart conditions?noyesdid in the pastDo you ever experience pain in your chest while exercising?noyesDo you ever lose balance because of dizziness or loss of consciousness?noyesIs your blood pressure high?noyesBlood pressure medicationDo you have muscle bone or joint conditions?noyesList the bone or muscle conditoins you haveDo you have any of the following conditions or any other conditions we should know about?Check all that apply Diabetes arthritis asthma other any other conditions we should know aboutDo you suffer back pain or any other kind pain?noyesDescribe the type of pain you experienceHave you had any surgery in the past two years?noyesDescribe the type of surgery you hadPhoneThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms. Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related
