Client Intake Form — Jt Spratley

Personal Information

First Name *

Preferred Name

Last Name *

Email *

Phone

Date of Birth

Emergency Contact Name

Emergency Contact Phone

Training Location

Facility *

Physical Activity Readiness (PAR-Q)

Please answer Yes or No to each question honestly. If you answer Yes to any question, physician clearance may be required before beginning an exercise program.

⚠️ You answered Yes to one or more PAR-Q questions. Please consult your physician before beginning an exercise program. Jt will follow up with you about physician clearance.

Additional Notes

Medical History

Current or Past Injuries / Surgeries

Chronic Conditions

Current Medications

Are you currently prescribed a GLP-1 medication?

e.g. Ozempic, Wegovy, Mounjaro, Zepbound

Yes No

Exercise History

Current Activity Level *

Beginner — never trained or very little experience Intermediate — trained before, currently inactive Active — currently training consistently Advanced — competitive or sport-specific training

Years of Training Experience

Additional Exercise History Notes

Goals

Primary Goal *

Tell Me More About Your Goals

Lifestyle

Occupation

Helps identify posture and recovery factors.

Daily Activity Level

Sleep Quality

Stress Level

Fasting?

Nutrition Notes

Availability

Preferred Training Time

Consent & Agreement

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