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Nancy B Fitness
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Client Intake Form
First name
Last name
Email
Phone
What is your current age
What is your date of birth
What is your current weight
What is your height
What are your overall fitness & health goals
What is your anticipated weekly commitment to exercise, including duration
Where will you be training
Home based workouts
Local Gym
Fitness Classes
If you will be working out at home, what equipment do you currently have
Are there any physical limitations that might affect your ability to perform exercises
Do you have any health conditions or past surgeries that may impact your exercise routine
Are there any food allergies you have? If so, please specify
Are there any food aversions you have? If so, please specify
How would you categorize your current activity level
Sedentary
Lightly Active
Moderately Active
Highly Active
Submit
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