The Flex Cult · Become a Personal Trainer
Client Intake & PAR-Q Form
Print and hand this to a new client before session one. This is an educational template — have it reviewed by a local professional before using it as a legal or medical document.
Client Information
Full Name
Date
Phone / Email
Emergency Contact
Health Screening (PAR-Q Style)
🚩 If the client answers YES to any question below, do not begin training. Obtain written physician clearance first.
Has a doctor ever said you have a heart condition, or should only do physical activity recommended by a doctor?YesNo
Do you feel pain in your chest during physical activity, or at rest?YesNo
Do you lose your balance because of dizziness, or have you lost consciousness in the last 12 months?YesNo
Do you have a bone or joint problem that could worsen with increased physical activity?YesNo
Is your doctor currently prescribing medication for blood pressure or a heart condition?YesNo
Have you had surgery, an injury, or pregnancy-related complication in the last 12 months without clearance to exercise?YesNo
Do you know of any other reason you should not do physical activity?YesNo
Basic Movement Assessment
Notes
Goals
Primary stated goal
What does achieving this actually mean to you? (the "why")
Behavior goal for this month (e.g. "train 3x/week")
Acknowledgment

I confirm that the information provided above is accurate and complete to the best of my knowledge, and I understand that physical exercise carries inherent risk. I agree to inform my trainer of any changes to my health status.

Client Signature
Date