Client Form

First name

Last name

Phone

Activity Level

Beginner (no current activity)

Intermediate (1-3 days/week)

Advanced (4+ days/week)

Medical History

Are there any current Medical Conditions I should know about? *May require doctor's clearance*

What is your Goal?

Ex) Tone up for a friends wedding, run a 5k, decrease back pain, increase athletic ability. Possible timeline?

I hereby, for myself and on behalf of participant, agree to the Assumption of risk for the benefit of Spirit Mind Body Adaptation LLC.

I acknowledge that exercise involve inherent risks, hazards and dangers may include bodily injury due to physical exertion.