New Clients

Client Intake Form

Please complete this form before your first visit. You can fill it out online and print it, or bring it with you to your appointment.

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Fill out all sections as completely as possible. Your information is kept strictly confidential and is used only to provide you with the best possible care.

1. Personal Information

Full Name

Date of Birth

Phone Number

Email Address

Address

Emergency Contact Name

Emergency Contact Phone

2. Health History

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

Heart conditionHigh blood pressureDiabetesCancer (current or history)OsteoporosisArthritisFibromyalgiaChronic painRecent surgeryPregnancySkin conditionsBlood clots / DVT

Current medications (list all)

Known allergies (latex, oils, lotions, etc.)

Recent injuries, surgeries, or medical procedures

Areas of pain, tension, or concern

Physician name and contact (if applicable)

3. Fitness History (Personal Training clients)

Current activity level

SedentaryLightly activeModerately activeVery active

Previous exercise experience

Primary fitness goals

Any physical limitations or movement restrictions

4. Session Preferences

Service(s) interested in

Massage TherapyPersonal TrainingBoth

Preferred massage pressure

LightMediumFirmDeep

Areas to focus on

Areas to avoid

Anything else I should know before your session

5. Consent & Signature

By completing this form, I confirm that the information provided is accurate to the best of my knowledge. I understand that this information will be used to tailor my sessions and ensure my safety.

Signature

Date

Client Intake Form

Forever In Training