Fitness Intake Form — The STRONG Clinic

The Basics

Full Name *

Email *

Phone

Age

How did you find The STRONG Clinic?

Your Body Right Now

Weight (lbs)

Height

Body Fat % (est.)

How often do you work out now?

Energy level (typical day)

Sleep — how many hours and how's the quality?

Training background — what have you done before?

Pain & Injuries

Current pain level (average)

0 — No pain10 — Severe

Describe any pain or discomfort (location, what makes it worse)

Current or past injuries that affect your training

Any medical conditions or medications we should know about?

Your Goals

What are you trying to accomplish? *

Timeline — when do you want to see results?

Days per week you can train

Session length available

Equipment available

Six months from now — what does success look like for you?

Nutrition (Optional)

How would you describe how you eat right now?

How often do you eat out?

Dietary restrictions or allergies

Do you meal prep?

Foods you avoid or don't like

Anything Else

Anything else Dr. Jon should know before building your program?

Your responses go directly to Dr. Jon. No spam, ever.

GOT IT.

Your intake is in. Dr. Jon will review it and reach out with next steps. Check your inbox for a confirmation.