Gym Intake Form

Information you will need

• Do you take any medications on a regular basis?
• What medications do you take?
• Do you know of any other reason why you shouldn't do physical activity?
• Can you expand on your health issues or concerns?
• What type of membership do you need?
• How long do you want your membership to be?
• Do you want to participate in personal training or classes?
• What type of personal training or classes are you interested in taking?
• What's your full name?
• Gym af image
• GYM ONLY: What's the gym's name?
• CLIENT ONLY: What's your name?
• What's your street address?
• What's your city?
• What's your state?
• What's your zip code?
• What's your email address?
• What's your phone number?
• How did you hear about the gym?
• What's your gender?
• What’s the name of your emergency contact?
• What's your emergency contact's phone number?
• Has your doctor ever said that you have a heart condition and should only do physical activity recommended by a doctor?
• Do you feel pain in your chest when you do physical activity?

…and 4 more fields in the PDF.

Completed by the client.

The form includes 1 signature line.