CLINT FORM

First Name

Email *

Phone *

Street and house number *

City *

Country *

Postal code *

Gender: *

Male Female

Occupation *

Do you have any known allergies, especially related to exercise equipment or materials? *

Are you currently taking any medications? If yes, please list them. *

List any past surgeries, injuries, or medical conditions. *

Multi-line text *

Current Health Status: *

Primary Fitness Goals: *

Weight Loss Muscle Building Increased Stamina Improved Flexibility

On a scale of 1 to 10, how would you rate your stress levels? *

Is there anything else you would like us to know or any specific concerns you have? *

How many hours of sleep do you typically get per night? *

What is your daily work routine like? *

Emergency Contact: *

How did you hear about us? *

Referral Social Media Website Other (please specify):

Declaration:
I declare that the information provided in this form is accurate and complete to the best of my knowledge. I understand that this information will be used to tailor a fitness program to my individual needs.

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