New Client

Fitness Assessment

Fill this out before your first session so Coach Shauna can build the right program for you. Takes about 10 minutes.

1 — Personal Information

Full Name *

Date

Date of Birth

Age

Phone *

Email *

Emergency Contact Name

Emergency Contact Phone

Primary Physician

Physician Phone

How did you hear about PhitFreaks?

Word of Mouth Social Media Google / Web Search Referral

If referred — by whom:

2 — Physical Stats & Goals

Height

Current Weight (lbs)

Goal Weight (lbs)

Goal Time Frame

6-Month Goal

Primary Goal(s) — check all that apply

Ultimate goal — be as specific as possible

3 — PAR-Q: Physical Activity Readiness

Answer YES or NO to each question honestly. If you answer YES to any question, consult your physician before increasing your physical activity.

1. Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?

YES NO

2. Do you feel pain in your chest when you do physical activity?

YES NO

3. In the past month, have you had chest pain when you were not doing physical activity?

YES NO

4. Do you lose your balance because of dizziness, or do you ever lose consciousness?

YES NO

5. Do you have a bone or joint problem that could be made worse by a change in your physical activity?

YES NO

6. Is your doctor currently prescribing drugs for your blood pressure or heart condition?

YES NO

7. Do you know of any other reason why you should not do physical activity?

YES NO

If YES to any above — please explain:

4 — Health & Medical History

Other conditions not listed:

Current or past injuries (describe area, severity, when it happened):

Any surgeries? (type and year)

Current medications or supplements:

Known allergies:

Do you smoke / use tobacco?

No Yes — cigarettes Yes — vaping Occasionally

Alcohol consumption

None Occasional (1–2x/week) Moderate (3–5x/week) Daily

Pregnancy / postpartum notes (if applicable):

5 — Training Background

Are you currently exercising regularly?

Yes No Inconsistently

If yes — frequency per week and current routine:

How many years have you been training (on and off)?

Have you worked with a personal trainer before?

Yes No

If yes — what did you like / dislike?

Prior competition experience — check all that apply

Competition notes (type, what you thought of it):

Do you have access to a gym?

Yes No — training at home Varies — travel often

If yes — which gym:

Equipment available to you (home, garage, etc.):

6 — Lifestyle & Daily Habits

Occupation / Job Title

Typical work hours per day

Job type

Mostly physical Mostly sedentary / desk-based Mix of both

Travel frequency for work:

Average hours of sleep per night

Stress level right now (1–10)

Support system at home for your fitness goals?

Yes No Somewhat

Typical daily diet — meals per day, timing, types of food:

7 — Self-Assessment & Coaching Preferences

Coaching style you respond best to

Positive encouragement & support Direct, tough-love — hold me accountable A mix of both

What motivates you most? What is your "why"?

Anything else Coach Shauna should know before your first session?

8 — Scheduling & Consent

Preferred time of day

Progress tracking consent — check all that apply

Periodic body measurements (waist, hips, arms, etc.) Progress photos for personal tracking — never shared without permission Sharing progress on PhitFreaks social media

✓ Your assessment has been submitted! Coach Shauna will be in touch soon.

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