Client Intake Form — Revere Fitness

★ This form is required before commencing training. All information is held in strict confidence and used solely to provide a safe, effective programme.

1. Personal Details

First Name

Last Name

Date of Birth

Gender

Occupation

Email Address

Phone Number

Home Address

2. Emergency Contact

Full Name

Relationship

Phone Number

3. Health & Medical History

Please indicate if you have been diagnosed with, or currently experience, any of the following:

Heart disease

High blood pressure

High cholesterol

Diabetes (Type 1 or 2)

Asthma / respiratory

Osteoporosis / arthritis

Chronic back pain

Thyroid disorder

Anxiety / depression

Pregnancy (current)

Recent surgery

Other (specify below)

Please describe any checked conditions or other relevant medical details

Current medications (if any)

GP / Doctor name & number

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4. Injury History & Physical Limitations

Do you have any current injuries? Yes No

Do you have any past injuries that still affect you? Yes No

Are there any movements or exercises you cannot perform? Yes No

If yes to any of the above, please describe

5. Training Background

Training experience

None < 1 year 1–3 years 3+ years

Current activity level

Sedentary Light Moderate Active

What types of training have you done before?

What has held you back from achieving your goals in the past?

6. Primary Goals

Fat loss / body recomposition

Muscle building / hypertrophy

Athletic performance

General fitness & health

Rehabilitation / injury recovery

Other (specify below)

Describe your main goal in your own words

7. Availability & Preferences

Sessions per week

Preferred days

Preferred times

Any other information you'd like me to know?

Declaration

I confirm that the information provided on this form is accurate and complete to the best of my knowledge. I understand it is my responsibility to inform my trainer of any changes to my health or medical circumstances.

Signature

Date