Welcome to Your Personal Training Journey!

Thank you for choosing to prioritize your health and fitness goals. To help me understand your needs and create a plan tailored just for you, please complete this intake form thoroughly. The more details you provide, the better I can design a program that supports your goals, preferences, and lifestyle.

Your honesty and completeness are greatly appreciated—I’m here to guide you every step of the way!

Tangie

Personal Information

First name

Last name

Gender

Phone

Date of Birth

Height

Weight

Health & Medical Information

Do you have any current or past medical conditions? (e.g., diabetes, heart issues, injuries):

Are you currently on any medications? If yes, please list:

Have you had any surgeries in the past year? If yes, provide details:

Do you have any physical limitations or restrictions?

Has your doctor cleared you for exercise?

Special Considerations

Have you had weight loss surgery? • If yes, what type of surgery? (e.g., gastric bypass, sleeve gastrectomy): • When did you have the surgery?

Have you had plastic surgery? • If yes, what type of surgery? • When did you have the surgery?

Are you currently using GLP-1 therapies (e.g., Ozempic, Wegovy, Mounjaro)? • If yes, when did you start? • How long have you been using the therapy?

Fitness Goals

If "other" please explain

Exercise History

Are you currently exercising? • If yes, describe your routine:

What types of exercise do you enjoy?

Have you worked with a personal trainer before? If yes, what worked and what didn’t?

On a scale of 1-10, how would you rate your current fitness level (1 = beginner, 10 = advanced)?

Lifestyle

What is your daily activity level? (Sedentary, lightly active, moderately active, very active):

Do you have any hobbies or sports you participate in?

How many hours of sleep do you typically get per night?

How would you rate your stress level? (Low, moderate, high):

Dietary Preferences

Do you follow a specific diet or have dietary restrictions? (e.g., vegetarian, gluten-free, allergies):

How many meals and snacks do you eat per day?

Do you track calories or macros? If yes, describe your method:

Are you currently taking any supplements?

Logistics

Do you prefer to workout at a gym or at home?

What equipment do you have access to? (e.g., dumbbells, resistance bands, treadmill):

How many days per week can you commit to working out?

How much time do you have for each workout?

What time of day do you prefer to work out?

Motivation & Accountability

Why do you want to start this program?

What challenges do you anticipate?

What keeps you motivated to reach your goals?

How can I best support you as your trainer?

Consent & Agreement

Are you willing to commit to the program and make the necessary lifestyle changes?

Yes

Signature

Sleeved and Shrinkng

50% Off All Teas

Black Friday

Code: BLACKFRIDAY

Sleeved & Shrinking
Detoxes & Cleanses for everyone, not just Weight Loss Surgery Patients

Personal Information

Health & Medical Information

Special Considerations

Fitness Goals

Exercise History

Lifestyle

Dietary Preferences

Logistics

Motivation & Accountability

Consent & Agreement

Sleeved and Shrinkng

50% Off All Teas

Black Friday

Code: BLACKFRIDAY

Sleeved & Shrinking Detoxes & Cleanses for everyone, not just Weight Loss Surgery Patients

Personal Information

Health & Medical Information

Special Considerations

Fitness Goals

Exercise History

Lifestyle

Dietary Preferences

Logistics

Motivation & Accountability

Consent & Agreement

Sleeved & Shrinking
Detoxes & Cleanses for everyone, not just Weight Loss Surgery Patients