Storm Fitness

New Client Forms


Client Information

 

Name: Date:
Address: Home Phone:
Date of Birth: Work Phone:
Email Address: Cell Phone:

 

Medical & Health Information

 

Do you now or have you had in the past:

1. History of heart problems, chest pain or stroke?  

2. Increased blood pressure?  

3. High cholesterol?   

4. Recent surgery (last 12 months)?  

5. Pregnancy (now or within last 3 months)?  

6. History of breathing or lung problems?  

7. Muscle, joint or back disorder, or any previous injury still affecting you?  

8. Diabetes or thyroid condition?  

98. Hernia, or any condition that may be aggravated by lifting weights?  

10. Any chronic illness or condition (osteoporosis, arthritis or cancer)?  

11. Are you taking any medications or drugs?  

12. Do you suffer from dizziness or loss of consciousness?  

13. Do you know of any other reason why you should not exercise?  

 

If you answered “Yes” to any of the above 13 questions, please explain below:

If you answered “Yes” to any of the above 13 questions, it is possible you may need a physician’s clearance note prior to beginning an exercise program with Storm Fitness, LLC. If necessary, Storm Fitness will contact you to request one.  A physician’s clearance note is required for all heart issues, pregnant clients, or clients that are pre/postnatal within the last three months. 

 

Lifestyle Analysis

 

Physical Activity:

Please describe your fitness history

Are you presently involved in any type of fitness program?   

 

If yes, what types of activities are involved in this program, for how long of a period and how many times a week?

Rate your perceived level of intensity for a typical workout on a scale from 1-10, 10 being the hardest  

 

How would you classify your activity level at work?      

 

Which activities would you like to see yourself engaged in on regular basis in the future? (check all that apply)

 

 

 

 

 

 

 

 
   Other?  

 

Do you have any time constraints on exercise?     

 

Diet & Nutrition:

Please describe your eating habits and nutrition (please include types of food and when they are eaten):

Is eating better and improving your nutrition part of your overall health goals?  

 

Do you have any dietary issues?

Do you get 7 or more hours of sleep each night?  

 

Goals & Objectives:

Describe what your health and fitness goals are:

 

Consent Form & Training Agreement 

 

INFORMED CONSENT 

Before starting any type of physical conditioning program, it is always best to consult your doctor and have a complete physical exam, which may include a stress test. Only after your doctor has given you clearance to exercise, should you begin any type of conditioning program that involves vigorous or strenuous exercise. 

 

By signing below, you are indicating that you understand that you will be participating in a personal fitness training session with Storm Fitness, LLC. You understand that the Storm Fitness personal trainers are unaware of any of your physical conditions and are not doctors. It is your responsibility to determine whether or not you are capable of undergoing strenuous physical activity.  Because the effects of the program depend, in part, upon the efforts of the individual, results may vary from person to person. Storm Fitness, LLC makes no warranties, guaranties, or claims, express or implied, regarding the extent of the benefits that any individual may or may not derive from the program. You understand that the nature and purpose of the program requires you to engage in strenuous physical activity and you agree that you are aware that any strenuous activity involves physical and mental risks. You hereby assume the risk of any and all accidents or injuries of any kind, which may be sustained by you through your participation in the program. By signing below, you hereby release, discharge and absolve Storm Fitness, LLC, including any and all of its employees, contractors, officers and directors, from any and all liability, claims or responsibility, now and in the future, for any such accident or injury arising from your participation in this program. You also hereby release, discharge and absolve Storm Fitness, LLC from any and all liability, claim or responsibility, now or in the future, for any such accident or injury arising from your participation in a personalized program designed for you by Storm Fitness, LLC to be performed on your own and without supervision by Storm Fitness, LLC. 

 

TRAINING AGREEMENT

By signing below you understand and agree that all sessions purchased are non-refundable after five days from the date of purchase, and the purchased sessions must be used within designated time frame from date of purchase or the sessions will be void. Payment for training sessions/installments must be made in advance of the next payment being due or services cannot be performed.  Your account summary and sessions will be tracked and a record will be given to you at the end of each package upon request.  If you purchase a package of 24, 50 or 100 sessions, a minimum of 2 sessions must be used per week. 4 sessions must be used in 1 month; 6 sessions in 1.5 months; 12 sessions in 3 months; 24 sessions in 3.5 months; 50 sessions in 6 months; 100 sessions within 1 year.  Sessions and packages are non transferable.

 

Cancellations made less than 24 hours prior to a scheduled workout will result in a charge of a full workout session against the account. A pre-scheduled session may be rescheduled for another time during that same day, pending availability.  Workout sessions last between 55-60 minutes.  If you are participating in a medically supervised exercise program, Storm Fitness, LLC will work with your doctor in carrying out the recommended rehabilitation program. Credit card payments are accepted online through PayPal services and all checks should be made out to Storm Fitness.

 

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Signature Certificate
Document name: New Client Forms
Unique Document ID: 5ababddab663939ee21b5842e5e814fb2670899c
Timestamp Audit
2016-12-22 15:18:25 ESTNew Client Forms Uploaded by Jessica Storm - jessica [at] stormfitness [dot] com IP 72.83.161.200