Goal Setting + Medical Form

Please don’t stress over this form. You can be as vague or as detailed as you want. I like to have this information on file, and it helps with the efficiency of our session.

First Name Last Name Email Address Phone Number

Please use the following format: ###-###-####

Birthday Emergency Contact Emergency Contact Phone Number

Please use the following format: ###-###-####

Current exercise routine: Goals: Ideal (realistic) workout frequency:

How often are you — realistically — committed to working out? Please indicate how many days and duration if possible. Ex: Mondays for 20 mins. Wednesdays for 60 minutes, etc.

Currently accessible fitness equipment:

Please list everything — no matter how old or silly you think it is.

Current/past injuries, illnesses, medications:

List any current or past injuries, illnesses, and/or medications I need to be aware of.