Intake form

Name *

Email address *

What are your primary fitness goals?

Please select at least one option.

Weight loss

Muscle building

Recovery

Rehabilitation

General fitness

Injury prevention

What is your current fitness level?

Do you have any previous injuries or medical conditions we should be aware of?

How many times per week do you typically exercise?

What type of training do you prefer?

Please select at least one option.

Cardio

Strength training

Flexibility training

Group classes

Personal training

What equipment do you have access to?

Please select at least one option.

Dumbbells

Resistance bands

Cardio machines

None

How did you hear about us?

Additional questions or comments

Kim Dale Physical Trainer