Please complete the following form to help us prepare for your initial session. Thanks!
Begin
 
Basic Information:

 
First Name *

 
Last Name *

 
Gender *


 
Birthday *

 
What is your phone number?

So we can call to discuss details further or to schedule a session.
 
Your preferred method of contact: *


 
We're excited you've found us. How did you hear about PerformanceGaines? *


 
Goals:

 
What is your current fitness goal? *

If possible, be specific.
 
Has there been a situation where you failed to reach a fitness goal? If yes, what prevented you from achieving that goal?

 
What outcomes motivate you to exercise? Please share up to 3. *

 
How confident are you that you can be consistent with a customized training program?

1 = I cannot do it at all
2 = I am highly certain I cannot do it
3 = I don't think I can do it
4 = I am somewhat certain I can do it
5 = I think I can do it
6 = I am highly certain I can do it
7 = I am absolutely certain I can do it *








 
To what degree do you feel you have control over your daily routines in life?

1 = Absolutely no control
2 = Little control
3 = Some control
4 = A lot of control
5 = Complete control *






 
What type of coaching do you respond best with? *


 
Fitness Experience:

 
Have you worked with a coach before?

     
 
Can you tell us about that experience, whether it be positive or negative? So that we know what works best for you.

 
List your top 3 intentions if working with a coach. *


 
Select the main way you’ve measured your success from your training in the past year. *


 
In the past 3 months, has your training included any of the following? *


 
List the top 3 factors on which you measure success in your endurance training.


 
List the top 3 factors on which you measure success in your strength training.


 
Are there any activities that you want to continue doing outside of training at PerformanceGaines?

 
What fitness equipment do you have?

At home? At the office? At another gym?
 
Habits:

 
Please describe your typical sleep quality. *

Choose as many as are applicable.

 
How many hours of sleep do you get a night? *

 
How do you typically feel in the morning after a normal night's sleep?

1 = Very rested
2 = Slightly rested
3 = Neither
4= Slightly unrested
5 = Very unrested *






 
Check all of the below that apply to you on most days in the past month. *


 
Which days can you train with a coach? *


 
What times of day would you be able to train with a coach? *

Scheduled training hours outside of normal business hours are to be discussed with your coach.

 
Would you be interested in some nutritional education? (i.e. What to eat, eating habits, convenience vs. healthy, etc.) *

     
 
Please share any injuries or limitations to your training routine.

Also include any lifestyle limitations or habits that would be counter-productive to your training.
 
Pricing:

 
All PerformanceGaines Coaches are independent. They determine their own rates and schedule. The prices below reflect an average range between coaches depending on their specialities and experience. Exact rates, session details, and programming will be discussed during your Discovery Session.

The $55/mo Access Pass is required for all clients.

Which training approach are you looking for? *

A coaching session is a service that is additional to a gym membership. Membership plans do not include personal training.

 
Open Gym Membership Plans: *

All memberships are recurring monthly plans. Cancellations require a 30-day notice.

Unused small group classes do not roll over.

 
Would you be interested in any of these additional services?

Each service may vary in price.

 
Release Forms:

 
Hazard Release *

I, {{answer_19366194}} {{answer_19366195}}, have been informed of, understand and am aware that strength, flexibility and aerobic exercise, including the use of weights and other equipment, are potentially hazardous activities. I also have been informed of, understand and am aware that fitness activities involve a risk of injury, including a remote risk of death or serious disability, and that I am voluntarily participating in these activities and using weights and equipment with full knowledge, understanding and appreciation of the dangers involved. I hereby agree to, and do, expressly assume and accept any and all risks of injury or death arising from or related to all such activities and use of weights and equipment.
I, {{answer_19366194}} {{answer_19366195}}, have been informed of, understand and am aware that strength, flexibility and aerobic exercise, including the use of weights and other equipment, are potentially hazardous activities. I also have been informed of, understand and am aware that fitness activities involve a risk of injury, including a remote risk of death or serious disability, and that I am voluntarily participating in these activities and using weights and equipment with full knowledge, understanding and appreciation of the dangers involved. I hereby agree to, and do, expressly assume and accept any and all risks of injury or death arising from or related to all such activities and use of weights and equipment.
     
 
Participation Release *

I, {{answer_19366194}} {{answer_19366195}}, in consideration of being allowed to participate in the personal fitness training activities and programs of PerformanceGaines LLC and to use the facilities, weights, equipment and services located at PerformanceGaines, in addition to the payment of any fee or charge, do hereby forever waive, release and discharge PerformanceGaines LLC, and their respective officers, agents, owners, members, trainers, employees, representatives, executors and all others acting with, for, or on their behalf (collectively, “Trainers”) from any and all claims or liabilities for injuries or damages to my person and/or property, arising out of or connected with my participation in any activities, programs or services offered by Trainers or the use of any weights or equipment at various sites, including but not limited to my home, provided by and/or recommended by Trainers.
I, {{answer_19366194}} {{answer_19366195}}, in consideration of being allowed to participate in the personal fitness training activities and programs of PerformanceGaines LLC and to use the facilities, weights, equipment and services located at PerformanceGaines, in addition to the payment of any fee or charge, do hereby forever waive, release and discharge PerformanceGaines LLC, and their respective officers, agents, owners, members, trainers, employees, representatives, executors and all others acting with, for, or on their behalf (collectively, “Trainers”) from any and all claims or liabilities for injuries or damages to my person and/or property, arising out of or connected with my participation in any activities, programs or services offered by Trainers or the use of any weights or equipment at various sites, including but not limited to my home, provided by and/or recommended by Trainers.
     
 
Physical Release *

I, {{answer_19366194}} {{answer_19366195}}, do hereby further declare myself to be physically sound and suffering from no condition, impairment, disease, infirmity or other illness that would prevent my full participation in these activities, including the use of weights or equipment. I do hereby acknowledge that I have been informed of the need for a physician’s approval for my participation in the exercise activities, programs and use of weights and exercise equipment. I also acknowledge that it has been recommended that I have a yearly or more frequent physical examination and consultation with my physician as to physical activity, exercise and use of weights and exercise equipment. I acknowledge that either I have had a physical examination and have been given my physician’s permission to participate or I have decided to participate in the exercise activities, programs and use of weights and equipment without the approval of my physician and do hereby assume all responsibility for my participation in said activities, programs and use of weights and equipment.
I, {{answer_19366194}} {{answer_19366195}}, do hereby further declare myself to be physically sound and suffering from no condition, impairment, disease, infirmity or other illness that would prevent my full participation in these activities, including the use of weights or equipment. I do hereby acknowledge that I have been informed of the need for a physician’s approval for my participation in the exercise activities, programs and use of weights and exercise equipment. I also acknowledge that it has been recommended that I have a yearly or more frequent physical examination and consultation with my physician as to physical activity, exercise and use of weights and exercise equipment. I acknowledge that either I have had a physical examination and have been given my physician’s permission to participate or I have decided to participate in the exercise activities, programs and use of weights and equipment without the approval of my physician and do hereby assume all responsibility for my participation in said activities, programs and use of weights and equipment.
     
 
Non-Medical Release *

I, {{answer_19366194}} {{answer_19366195}}, understand that Trainers providing and maintaining an exercise/fitness program for me does not constitute an acknowledgment, representation or indication of my physiological well-being or a medical opinion relating thereto.
I, {{answer_19366194}} {{answer_19366195}}, understand that Trainers providing and maintaining an exercise/fitness program for me does not constitute an acknowledgment, representation or indication of my physiological well-being or a medical opinion relating thereto.
     
 
Photographic & Media Consent Form

I, {{answer_19366194}} {{answer_19366195}}, hereby consent to the collection and use of my personal images by photography or video recording.   I acknowledge these may be used on the PerformanceGaines website, in newsletters and publications, as well as distributed to members. I understand that no personal information, such as names, will be used in any publications unless express consent is given.   I give this consent voluntarily.    I also understand that my consent can be withdrawn at anytime in writing to Christopher Gaines at chris@performancegaines.com.  I give this consent voluntarily.
I, {{answer_19366194}} {{answer_19366195}}, hereby consent to the collection and use of my personal images by photography or video recording.   I acknowledge these may be used on the PerformanceGaines website, in newsletters and publications, as well as distributed to members. I understand that no personal information, such as names, will be used in any publications unless express consent is given.   I give this consent voluntarily.    I also understand that my consent can be withdrawn at anytime in writing to Christopher Gaines at chris@performancegaines.com.  I give this consent voluntarily.
     
 
As a client athlete, we want you to have a great experience and relationship with your team, from day one. Is there any information you want us to know that will help us better serve you?

Thank you for completing the intake form!
We'll be in touch shortly to schedule your Discovery session.
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