SHF Consult Form

First Name *

Last Name *

Phone *

Email *

Date of birth *

Do you have any medical conditions? *

Do you currently take any medication? *

Have you had any surgeries or injuries in the past? *

Do you have any physical limitations or disabilities? *

Preferred Training Days (select all that apply)

Do you have any other specific health concerns or injuries I should be aware of that you have not yet identified? *

Fitness Goals (Select all that apply) *

How important is it for you to achieve this goal? *

Not Important

Somewhat Important

Very Important

Extremely Important

With your goal in mind, please type below how much per week you are happy to spend on achieveing this. *

$

Have you worked with a personal trainer / online coach before? If yes, what did you like or dislike about the experience? *

Do you have any concerns or questions about personal training / online coaching? *

Assuming we are a good fit for each other going forward, what are your expectations of me as your coach? (please be as specific and honest as possible) *

Which service are you interested in the most? *

I Consent to Receive Texts, Emails & Occasional Marketing Communication from Sam Howes.

By signing below you are acknowledging that the information you have provided on this form is correct. And that you will inform me / a fitness professional if there are any changes in my health status. I understand that participating in physical activity and exercise can carry a risk, and accept all responsibility for that risk. I understand that due care will be taken by Sam Howes at all times. *

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