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Home
About Us
Services
Client Profile Form
CPR Certification
Private Training Rates
Contact Us
CLIENT
PROFILE FORM
"
*
" indicates required fields
General Information
Name
*
First
Last
Email
*
Gender
*
Male
Female
Phone Number
Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Cell Phone
*
Date of Birth
*
What is/are your purpose(s) for participating in a fitness program?
*
To determine my current level of physical fitness and receive recommendations for a program
Seeking a new challenge and change of pace from my regular routine
I am brand new to fitness and need help starting from square one
Other
What services are you interested in (select more than one)
*
Online Coaching
Private Training
Semi-Private Training
TeamFITT Bootcamp
Self-directed program
Nutrition coaching and plan design
Workshops (in-person/online)
If 'Other', Please explain here
What forms of exercise/activities have you enjoyed in the past?
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Define your current level of activity
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Very Active (6+ days per week)
Active (3-5 days per week)
Somewhat Active (1-2 days per week)
Sedentary (0-1 days per week)
If you are not able to exercise regularly, explain why
*
What are your expectations of a coach?
*
How many days per week can you commit to an exercise program?
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1 - 2 days per week
3 - 4 days per week
5 - 7 days per week
Do you have access to equipment at home or at a gym?
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I have equipment and access to a gym
I have equipment at home but no access to a gym
I do not have equipment at home or a gym membership
Medical History
Do you have any allergies or medical conditions that we should be aware of?
*
Yes
No
If 'Yes', please specify and include what medication you are taking for the(se) condition(s)
Do you or anyone in your family have or have had a history of one or more of the following:
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Heart Attack/Stroke/Angina
Diabetes
Inflammation
Cardiovascular Disease
Obesity
Poor Circulation
Goals / Objectives
What are your areas of concern (target areas you would like to focus on)?
*
What are your top 3 fitness and wellness goals that you would like to achieve this year?
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How have you made efforts to accomplish these goals presently or in the past?
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At GoodFITT, we believe that having a "why" is a key to goal accomplishment. What's your "why"?
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Ectomorph, Mesomorph, or Endomorph
Complete the following questionnaire to determine your body type.
My Forearms Look...
*
Big
Average
Small
Concerning My Weight, I...
*
Gain weight easily, but find it challenging to lose
I can gain and lose weight without much of a struggle
Have trouble gaining weight in the form of muscle or fat
My Shoulders Are..
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Wider than my hips
The same width as my hips
Narrower than my hips
A Pair of Relaxed-Fit Jeans (with a correct waist size) Fits...
*
Tight around my glutes
Perfect around my glutes
Loose around my glutes
My Body's Appearance...
*
Pear-shaped (women)
Hourglass-shaped (women)
Mostly straight up and down (women)
Round and soft (men)
Square and rugged (men)
Long and narrow (men)
My Body Has the Tendency To...
*
Carry a bit of extra fat
Stay lean, yet muscular
Stay slender
If I Encircle My Wrist With My Other Hand's Middle Finger and Thumb...
*
The middle finger and thumb don't touch
The middle finger and thumb just touch
The middle finger and thumb overlap
My Chest Measurement Range is Between
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42 inches or more (women)
35-42 inches (women)
35 inches or less (women)
43 inches or more (men)
37-43 inches (men)
37 inches or less (men)
Nutrition History
How many meals do you eat per day including snacks?
*
1-2 meals per day
3-4 meals per day
5-6 meals per day
Are you a...?
*
Meat-eater
Vegatarian
Pescatarian (fish/seafood only)
Vegan
Do you have any food allergies / dietary restrictions?
*
What type of eater are you?
*
Stress eater
Emotional eater
Over-eater
Eat-too-little
Daily Meal Snap Shot
Provide a mini journal of your meals each day. Be as clear and honest as possible! We won't judge you:-)
Breakfast
*
Lunch
*
Dinner
*
Snack 1
*
Snack 2
*
Snack 3 (if applicable)
*
Confidentiality Agreement and Waiver of Liability
By clicking 'submit', I certify that I have fully disclosed all pertinent information in an honest and truthful manner.
All client information is confidential and remains confidential between the client and GoodFITT Personal Training & Wellness Services. Information shall not and will not be shared with third parties without the expressed written consent of the client. This includes any statistical or image-based information acquired from the client as per agreement between GoodFITT Personal Training & Wellness Services and the client.
WAIVER OF LIABILITY – This is a release of claims and by clicking submit you do the following: (1) represent to “GoodFITT Personal Training & Wellness Services” that you are in excellent physical health, (2) agree to expressly assume and accept any and all risks of injury or death, (3) forever waive, release and discharge “GoodFITT Personal Training & Wellness Services” and its trainers, instructors, officers, agents, employees, representatives, executors, and all others acting on their behalf from any and all claims or liabilities for injuries or damages to your person and property, including those caused by the negligent acting on their behalf, arising out of a or connected with my participation in any activities, programs or services of “GoodFITT Personal Training & Wellness Services”, or the use of any equipment provided by and/or recommended by “GoodFITT Personal Training & Wellness Services.”
RENONCIATION A TOUTE RECLAMATION – Ce qui suit est un degagement de toute responsabilite, et en le signant, vous faites les affirmations suivants: (1) vous assurez “GoodFITT Personal Training & Wellness Services” que vous etes en excellent santé physicque, (2) vous acceptez explicitement d’assumer tous et n’importe quell risqué de blessure ou deces, (3) vous renoncez, liber, et acquitte pour toujours “GoodFITT Personal Training & Wellness Services” et ses entraineurs, instructeurs, fonctionnaires, agents, employees, et tous autres representants qui agirent au nom de “GoodFITT Personal Training & Wellness Services”, de ne pas etre tenu au versement de dommages-interets de tout et n’importe quelle demande ou responsabilite de blessure ou dommages sur ma personne ou materiel, incluant ceux causes par un comportement negligent de leur par du a/ou relier a la participation d’activites, programmes ou services offerts par “GoodFITT Personal Training & Wellness Services” ou l’utilisation d’equipement fournie par et/ou conseiller par “GoodFITT Personal Training & Wellness Services.”
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