Client Intake Form

The goal of our client intake form is to screen candidates to make sure they qualify for System 7 Training and are a good fit. Our success rate in our program is extremely high due to the fact that we make sure you are capable of passing certain tests. Please fill out the form in its entirety if you are interested in becoming a member.

system 7 training hinsdale IL

Your Full Name (required)

Your Address (City - State - Zip)(required)

Your Email (required)

Your Phone (required)

Prefer To Be Contacted By (required)

Your Age (required)

Your Birthdate (required)

Primary health & Fitness Goals (required)

Have You Attempted Any Of These Goals Previously? (required)

If Yes, Were you successful? (required)

If No, why do you think you weren't successful? (required)

Please rate 1-10 | 1=Not At All Committed 10=Do What Is Necessary

How committed are you to achieving your goal(s)? (required)

Have you had lab work (blood draw w venipuncture) done in the past 12 months? (required)

If No, continue to next question on medications

If Yes Continue Here

When was your most recent blood test done? (Insert field for date) (required)

For what reason did you doctor order the lab test?

Did your doctor contact you w feedback on the results of your lab test?

If yes, please explain here what your understanding is about the results.

What advice did you doctor give you in regards to the test results?

In your opinion, how would you score yourself on the degree to which you've followed your doctor's advice? (1-10, 1 is I've done nothing; 10 is I've followed doctor's advice perfectly.) (required)

List all medications (required)

List injuries and surgeries (required)

What sports do you enjoy? (required)

What athletic activities do you least enjoy? (required)

What is your relationship with food? (required)

List vitamins or supplements you take, or have taken. What brand? and from whom do you get them. (required)

How many ounces of water do you drink daily? (required)

How many ounces of caffeine do you drink daily? (required)

How many hours of sleep do you get? (required)

On a scale of 1-10, what is your current stress level? 1=LOW 10=HIGH (required)

How many hours a week can you commit to living a healthier lifestyle? Time to exercise, shop/prepare meals, time to rest and recover. (required)

List any barriers that you believe could prevent you from achieving your goals. Job, Family, travel, etc. (required)

What is your target date to achieve one or all of your goals? (Insert field for date) (required)

Preferred days for your training sessions (55 minute sessions) (required)

Preferrred time of day for your training sessions (55 minute sessions) -Ideally, same time on each training day (required)

Where do you want to train? (required)

Any Additional info You Want to Add