First Name
Last Name
Email Address
Phone Number
Date of Birth
Gender
Street Address
City
State/Province
Postal/Zip Code
Emergency Contact Name
Emergency Contact Number
Preferred Method of Communication
What are your primary fitness goals? (Check all that apply)
Weight Loss
Muscle toning
Stress relief
Increased strength
Cardiovascular fitness
Rehabilitation/recovery
Other (Please specify):
Do you have any specific areas of focus? (Check all that apply)
Core strength
Lower body
Upper body
Balance
Other (Please specify):
Do you have any medical conditions or injuries that may affect your ability to participate in physical activity?
Are you currently under the care of a physician or physical therapist?
Have you ever had surgery or been hospitalized for a medical condition?
Do you experience any of the following? (Check all that apply)
Chronic pain (e.g., back, knee, shoulder)
Joint issues (e.g., arthritis, stiffness)
Heart conditions
Respiratory issues (e.g., asthma)
High or low blood pressure
Diabetes
Other (Please specify):
Are you pregnant or postpartum?
Do you have any allergies or dietary restrictions?
What is your current fitness level?
Beginner
Intermediate
Advanced
Have you participated in Yoga, Pilates, or HIIT classes before?
How often do you currently exercise?
Never
1-2 times per week
3-4 times per week
5+ times per week
What types of exercise do you currently engage in?
Which types of classes are you interested in? (Check all that apply)
Program | Click if apply | |
|---|---|---|
Yoga | ||
Hatha Yoga | ||
Vinyasa Flow | ||
Restorative Yoga | ||
Yin Yoga | ||
Power Yoga | ||
Prenatal Yoga | ||
Pilates | ||
Mat Pilates | ||
Reformer Pilates | ||
Advanced Pilates | ||
HIIT | ||
Bodyweight HIIT | ||
Cardio HIIT | ||
Strength-Based HIIT | ||
Low-Impact HIIT |
What is your preferred class duration?
30 minutes
45 minutes
60 minutes
75+ minutes
What time of day do you prefer for classes?
Morning (6:00 AM - 9:00 AM)
Midday (10:00 AM - 2:00 PM)
Evening (5:00 PM - 8:00 PM)
Night (8:00 PM - 10:00 PM)
Do you prefer live classes or pre-recorded sessions?
Live classes (interactive)
Pre-recorded sessions (flexible timing)
Both
How would you describe your stress levels?
Low
Moderate
High
How many hours of sleep do you get per night on average?
Less than 5 hours
5-7 hours
7-9 hours
More than 9 hours
Do you smoke or consume alcohol regularly?
Do you follow a specific diet?
Vegetarian
Vegan
Keto
Gluten-free
Other (please specify):
Do you have access to the following equipment? (Check all that apply)
Yoga mat
Pilates mat
Dumbbells
Resistance bands
Stability ball
Foam roller
None
How much space do you have for exercising at home?
Small (enough for a yoga mat)
Medium (enough for light movement)
Large (enough for full-range exercises)
Is there anything else you would like us to know about your fitness journey, preferences, or limitations?
I confirm that the information provided above is accurate to the best of my knowledge.
I understand that it is my responsibility to consult with a physician before starting any new fitness program, and I assume all risks associated with participating in online classes.
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