New Client Intake Form Welcome to Sand & Steel!Our New Client Intake form helps us prepare for your gym tour & consult. We use it as a guide in building out your future personal training, nutrition, and/or yoga program. Please fill out this form before your first consult.Sand and Steel FitnessNew Client Intake FormTakes about 10 Minutes to CompleteName* First Last Email* Phone*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Male or Female?*MaleFemaleDate of Birth* Age?*Height*Weight in Pounds*Weight in Pounds when your were 21 years old*Health HistoryDo You have any Current Injuries?*Include any type of pain in joints, muscles, back, neck, etc.YesNoPlease Describe Your Current InjuriesAre you looking for our help with any of your injuries? How can we be of help?*Do You have any Past Injuries?*Include any type of pain in joints, muscles, back, neck, etc.YesNoPlease Describe Your Past InjuriesHow Important is Mobility / Flexibility / Corrective Exercise to you?*Not ImportantSomewhat ImportantVery ImportantMain Reason I am coming to Sand & SteelNot SureDo You have Any Mobility Restrictions?*E.g. are you tight in certain places? Do you have limited range of motion?YesNoPlease Describe the Mobility RestrictionsList all sports you currently play and any sports you played in the past (and when)What Fitness Supplements are you using?What Medications are You Taking?Which Services Are You Interested In?Check the boxes for the services that you'd like us to discuss with you on your consult Personal Training Partner Training Nutrition and Diet Coaching Mobility and Flexibility Training Private Yoga Sessions InBody Composition ScanWhen we build new programs at Sand & Steel, we design it to have a primary and secondary focus. To help us pick the optimal program for you, please rank the following workout program aspects in terms of importance to you.Appearance Emphasize looking better with focus on looking trim and fit (mixed weight loss and muscle building/sculpting)Health Emphasize improving internal health and energy levels.Hypertrophy Emphasis on muscle volume development e.g. Bodybuilding style programming.Strength Power Lifting or Functional Strength Training.Weight Loss Some of our programs are designed to burn fat -- pure and simple. Bring the Sweat.Mobility and Flexibility Build the requisite flexibility and neurological control (coordination) to enable specific joints and muscles to perform a specific exercise correctly.Corrective Exercise and Recovery If you are already in pain, we can help by providing you with the corrective exercises to strengthen the biomechanical weaknesses causing your pain. If you are not in pain, but you are susceptible to injury (e.g. bulging discs, rotator cuff injury, history of pulling hamstrings, etc) we can analyze your movement patterns, and build muscle to strengthen weaker areas to improve your resistance to re-injury.Conditioning and General Physical Preparedness Build the capacity to do workout or athletic activity that comes in your way. Last longer playing tennis, ski that extra run at 4:00PM, and generally have more energy for every day tasks. Conditioning builds willpower and the ability to keep going when others quit.Choose Your Primary Goal*E.g. Which of the following 6 Aspects is Most Important to You.HealthAppearanceHypertrophyStrengthWeight LossMobility and FlexibilityCorrective Exercise and RecoveryConditioning and General Physical PreparednessChoose Your Secondary Goal*E.g. Which of the following 6 Aspects is second most Important to You.AppearanceHealthHypertrophyStrengthWeight LossMobility and FlexibilityCorrective Exercise and RecoveryConditioning and General Physical PreparednessDo You Have any Comments about your Goals to Add?We specialize in matching the right program to the right client. To do that effectively, we need to know what you like and what you don't like.How Many Times Per Month Would you Like to Train at Sand & Steel?*Pricing Ranges from $80-$90 per session. Most clients come between 4-12 times Per MonthHave you hired a personal trainer before? What was your experience with that coach?There are lots of gyms that offer personal training ... what made you decide to try us out?Where did you hear about Sand & Steel?If someone referred you, let us know who. You both get an extra discount.My Current Fitness Regime Includes:Yes, we can build you a program that works with your other fitness programming. Personal Training at another Gym. Open Gym at Sport & Health, Gold's, etc. Home or Work Gym CrossFit Orange Theory Yoga Pilates Swimming Running Cycling Walking None OtherDo You have any fitness or yoga certifications?*YesNoHow Intense Do you Like to Train*Perfect Form and Safety Are Always Prioritized at Sand & Steel. Still some people like more or lesser intensityMild. I am new to working out and want to go slowMedium. I am Ok with working out moderately hard.Hard. I like to be sore after my workout.Max. Take me to the maximum, while still keeping safety and good form.Describe the kind of Programming / Training you are looking for.*In your own words, please describe the kind of program you are looking for. We custom create programs to fit our client's goals, injuries, and capabilities.Special Occasions & EventsIs there an event that you are preparing for? Maybe it's beach vacation in August and you want to wear a bikini. Maybe you are running a Tough Mudder in September. If there is an event that you have scheduled or plan to schedule, please let us know. This way we can consider progressions during your program.Who else are you considering?We are happy to provide you with information about all fitness and training companies in the Alexandria VA area.I have read and agree to the terms of the Personal Training AgreementPersonal Training Agreement AgreedI have read and agree to the terms of the Personal Training Agreement*Personal Training AgreementI have read and agree to the terms of the Informed Consent*Informed ConsentI have read and agree to the terms of the Informed ConsentInformed Consent AgreedComments, Questions, Requests?If there is anything you want to us cover in the consult or any other information/questions you'd like to add. Please do. We will read everything you write.You are all set! Your first session is a free consultation, so you can come in your suit, jeans, or whatever you normally wear.NameThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.