Driven by Dusty | Client Intake Form

01Personal

02Health

03Fitness

04Lifestyle

Step 1 of 4

Personal Information

Basic contact details so we can reach you and keep your records up to date.

First Name * Please enter your first name.

Last Name * Please enter your last name.

Date of Birth * Required.

Gender

Pronouns

Email Address * Please enter a valid email.

Phone Number * Please enter your phone number.

Step 1 of 4

Step 2 of 4

Health History

Your safety is our top priority. Please answer as accurately as you can.

Height

Weight

Occupation

Do you have any of the following? (check all that apply)

Heart condition or cardiovascular disease High blood pressure Diabetes (Type 1 or Type 2) Asthma or respiratory issues Chronic joint pain or arthritis Osteoporosis or bone density issues None of the above

Injuries & Physical Limitations

Current or previous injuries

Medications / supplements

Dietary Restrictions & Allergies

Dietary approach

Food allergies or intolerances

Any other dietary restrictions or notes for your trainer?

Physician Clearance

Have you been cleared by a doctor for exercise?

Yes No N/A — no conditions

Primary care physician (optional)

Women's Health (if applicable)

Are you pregnant, postpartum, or perimenopausal?

Step 2 of 4

Step 3 of 4

Fitness Goals & Experience

Tell us where you've been and where you want to go.

Primary Goals (check your top 3)

Lose weight / reduce body fat Build muscle / increase strength Improve endurance / cardiovascular fitness Improve flexibility & mobility Enhance sport / athletic performance Injury recovery / rehabilitation General health & wellness Stress management & mental wellbeing

Describe your goal in your own words

Exercise Background

Experience level

Beginner Some experience Intermediate Advanced

Years of consistent training

What types of exercise have you done before?

Preferences & Dislikes

Exercises you enjoy

Exercises you dislike or want to avoid

Current weekly activity (outside of PT sessions)

Step 3 of 4

Step 4 of 4

Lifestyle & Schedule

Your lifestyle shapes your program. The more we know, the better we can plan.

Hydration & Habits

Avg. water intake

Alcohol consumption

Sleep & Recovery

Average nightly sleep

Overall stress level

LowHigh

Training Schedule

Sessions per week with trainer

1× 2× 3× 4+

Preferred session length

30 min 45 min 60 min 90 min

Best days to train

Mon Tue Wed Thu Fri Sat Sun

Preferred time of day

Early AM Morning Midday Afternoon Evening

Training Environment

Primary training location

Gym Home Outdoors Mix

Equipment available

Anything else you want me to know?

Something went wrong — please try again or email me directly.

You're all set.

Thanks for completing the intake form. I'll review your answers and be in touch within 24 hours to schedule your first session.