Client Questionaire

/Client Questionaire
Client Questionaire 2018-07-09T07:11:22+00:00
Please complete and return to J. Carlos Fitlab by Mail or E-mail listed below at least 2 days prior to your first scheduled session.

All information received on this form will be treated as strictly confidential. Please fill out the forms completely and accurately. This information is essential to helping your trainer develop a program that addresses your needs, goals and interests and is safe and effective.

Client Information

Your Name: (required)

Date of Birth: (required)

Age: (required)

Your Address: (required)

Phone Number: (required)

Your Email: (required)

Employment Information

Occupation: (required)

Employer: (required)

Emergency Contract Information

Primary: (required)

Relationship: (required)

Phone Number: (required)

Secondary: (required)

Relationship: (required)

Phone Number: (required)

Medical Contact Information

Physician's Name: (required)

Physician's Phone Number: (required)

Physican's Address: (required)

Physician's Email: (required)

Physician's Network: (required)

J. Carlos FitLab will send information regarding your physical exercise program to your physician unless you request otherwise.

Please provide 48 hours notice if you need to cancel or reschedule your Personal Training appointment.
J. Carlos FitLab
P.O. Box 19329
Portland, OR 97280
Fax: 503-246-0240