Hybrid Intake Form | GENTLE STRENGTH

I'm so excited to help you build a sustainable strength training practice. We are going to have a lot of fun getting strong together! To help me build a program that works best for you, please answer the questions in this form. Please also ensure that you have agreed to the liability waiver.

First name

Last name

Preferred Pronouns

Address

Phone

By submitting your phone number, you provide express written consent to contact you via SMS. Message frequency varies. Message and data rates may apply. Text STOP to opt out. View privacy policy (https://www.gentlestrength.info/privacy) & SMS terms (https://www.gentlestrength.info/smsterms).

Birthday

Emergency Contact Name and Phone Number

Do you have any specific goals for your training in the next 6 months? What are you hoping to gain through strength training?

How frequently would you like to complete strength workouts on your own? (If you aren't sure, I usually recommend starting with 2 x week!)

How much time do you have for each workout?

10-20 min

30-40 min

50-60 min

Where do you plan to complete your workouts on your own, and what equipment will you have access to? (be as specific as possible)

Do you have any injuries or chronic conditions that may affect your training? Please explain with as much detail as possible.

Have you been diagnosed with low bone density? (Oestoperosis or Oesteopenia)

Yes

Have you had any surgeries in the past 5 years that could impact your training? If so, please explain.

Are you on any medications that could impact your training? If so, please explain.

Have you been pregnant or given birth in the past two years?

Yes

Do you experience any symptoms of decreased pelvic health? Such as: leaking with sneezing/laughing/jumping, heaviness in your pelvic area, general pelvic and/or hip pain and stiffness, etc.

Are there specific movements that you know will be especially challenging or out of reach for you currently? (For example, kneeling on the floor, bearing weight on wrists, balancing on one leg, lifting arms strait overhead, etc.)

Is there anything else you want me to know about you before we start training?

Liability Waiver

I, the undersigned, being fully aware of my own physical health and condition, and having clear knowledge that my participation in any exercise activity may be injurious to my health, am voluntarily participating in a physical exercise program created by Anne Schwalbe.

Having such knowledge, I hereby acknowledge and grant this release, and hold harmless Anne Schwalbe and representatives, agents, and successors from liability of accidental injury or illness that I may incur as a result of participating in the said physical exercise program. I hereby assume all risks in connection therewith and consent to participate in said program.

I agree to disclose any physical limitations, disabilities, ailments, or impairments which may affect my ability to participate in the said physical exercise program.

I have read and agree to the liability waiver.

I have read and agree to the missed class, refund, and other policies found here: https://www.gentlestrength.info/faq

I am vaccinated against COVID-19.

Signature

Hybrid Personal Training Intake Form

Liability Waiver

Hybrid Personal Training
Intake Form