NEW CLIENT INTAKE FORM | Wolves Den Fitness

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First name*

Last name*

Gender*

Female

Male

Phone*

Email*

Age*

Birthday

Month

Day

Year

Height?*

Current Weight?*

What are your health/ fitness goals? *be as specific as possible*

What is your current fitness routine if any?*

Occupation?*

What is your average step count per day?*

Do you have any injuries or physical restrictions I should know about?*

Do you have any food allergies or sensitivities?*

Have you experienced trauma? *you do NOT need to provide details*

Yes

No

How is your mental health?

Great

Good, but could be better

Needs improvement

Poor

Have you ever been diagnosed with an eating disorder?

Yes

No

Prefer not to say

How many days a week would you like to workout?

3

4

5

What is your experience level in the gym?*

Beginner (none or very little experience)

Intermediate (some experience but not confident with everything)

Advanced (a lot of experience, pretty confident navigating the gym)

Where do you have a gym membership? *please provide name of gym and location**

How did you hear about us?*

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Phone*

Email*

How Did You Hear About Us?*

I am interested in:*

Online Training

In Person Training

A Custom Program

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