Thank you for choosing [Your Studio/Name] for your online fitness journey! Please complete this form to help us understand your needs and ensure you have a safe and effective experience.
First Name
Last Name
Email Address
Phone Number
Date of Birth
Street Address
City
State/Province
Postal/Zip Code
Preferred Method of Communication
Have you been cleared by a doctor for physical activity?
Yes
No
I am unsure (If unsure, please consult your doctor before participating)
Do you have any current or past injuries, illnesses, or medical conditions? (e.g., back pain, knee issues, heart conditions, pregnancy)?
Are you currently taking any medications?
Do you have any allergies or sensitivities?
For Female Clients: Are you currently pregnant or postpartum?
Do you experience any pain or discomfort during physical activity?
Are there any specific movements or exercises that you should avoid?
What are your primary fitness goals? (Check all that apply)
Weight Loss
Increased Strength
Improved Flexibility
Stress Reduction
Improved Cardiovascular Health
Improved Posture
Increased Energy Levels
Mindfulness/Relaxation
Other (Please specify):
What is your current fitness level?
Beginner (New to exercise)
Intermediate (Regular exercise)
Advanced (Highly active)
Have you participated in Yoga, Pilates, or HIIT classes before?
Program | Yes/No | If yes, how often? | |
|---|---|---|---|
Yoga | |||
Pilates | |||
HIIT |
What type of exercise do you enjoy most?
Yoga
Pilates
HIIT
A combination
Other:
How often do you plan to participate in online classes?
1-2 times per week
3-4 times per week
5+ times per week
What time of day do you prefer to exercise?
Morning
Afternoon
Evening
Anytime
Do you have any equipment at home? (e.g., yoga mat, weights, resistance bands)
Please indicate your interest in the following online classes (check all that apply)
Class Name | Check if apply | |
|---|---|---|
Yoga | ||
Hatha Yoga (Gentle, foundational) | ||
Vinyasa Flow (Dynamic, flowing) | ||
Restorative Yoga (Relaxing, passive) | ||
Yin Yoga (Deep stretching, meditative) | ||
Yoga for Beginners | ||
Yoga for Flexibility | ||
Yoga for Stress Relief | ||
Pilates | ||
Mat Pilates (Classic, bodyweight) | ||
Pilates for Core Strength | ||
Pilates for Flexibility | ||
Pilates for Beginners | ||
HIIT | ||
Beginner HIIT (Low-impact options) | ||
Intermediate HIIT (Moderate intensity) | ||
Advanced HIIT (High intensity) | ||
HIIT for Fat Loss | ||
HIIT for Cardio | ||
Combo Yoga/Pilates | ||
Combo Pilates/HIIT | ||
Combo Yoga/HIIT |
Do you have any space limitations at home?
Do you have any concerns about participating in online classes?
Are you comfortable using online platforms like Zoom or others for live classes?
Do you have reliable internet access and a suitable device (computer, tablet, smartphone) for online classes?
Liability Waiver: I understand that participating in online fitness classes involves physical activity and potential risks. I hereby release [Your Studio/Name] and its instructors from any liability for injuries or damages that may occur during or as a result of my participation. I acknowledge that I am responsible for consulting with my doctor before starting any new exercise program.
Privacy Policy: I understand and agree to the privacy policy of [Your Studio/Name] regarding the collection and use of my personal information.
Cancellation Policy: I understand and agree to the cancellation policy of [Your Studio/Name] for online classes.
Client Signature
Thank you for completing this form. We look forward to helping you achieve your fitness goals!