Intake Form

Email*

Name

Address*

Phone*

Date of Birth*

Occupation*

Emergency Contact Name and Number*

Any prior injuries or illnesses we should be aware of?*

Are you pregnant? If so, how far along are you?

Are you on any medications?*

Briefly describe your current fitness/activity level.*

What are your primary goals that you think RE:TRAIN can help with?*

Do you have any prior experiences with movement coaches or fitness trainers? What did you like or dislike about it?

What other treatments or practices have you found the most helpful so far?

What treatments or practices have you tried that seemed ineffective?

How much average time per day do you get to set aside for personal health and fitness practices*

How many days per week are you wanting guided instruction?*

Any other information you think we should know?

Please fill this out before our consultation.

Evolve Strength Royal Oak

#600-8888 Country Hills Blvd NW
Calgary, AB

ben@retrainmovement.com

604 619 1490