Lifestyle Form


    How often do you check email?


    Date of Birth:

    Exercise History

    Were you a high school or college athlete?

    Do you have any negative feelings towards, or have you had any bad experiences with physical activity programs?

    Rate yourself on a scale of 1 to 5 (1 indicating the lowest and 5 the highest). Select the number that best applies.

    Characterize your present athletic ability

    When you exercise, how important is competition?

    Characterize your present cardiovascular capacity

    Characterize your present muscular capacity

    Characterize your present flexibility capacity

    How much time are you willing to devote to an exercise program?

    Are you currently involved in regular endurance (cardiovascular) exercise?

    Rate your perception of your exercise program (1=light, 2=fairly light, 3=somewhat hard 4=hard 5=very hard)

    How long have you been exercising regularly?

    What other exercise, sport, or recreational activities have you participated in?

    Can you exercise during your work day?

    Do you have a gym in your building?

    Do you currently belong to a gym? If so, which one?

    What types of exercise interest you?
    WalkingCyclingStair ClimbingJoggingAerobicsSwimmingYoga/PilatesRacquet SportsStrength TrainingOther

    What time of day do you prefer to train?
    Early morning 6am-9amMorning 9am-12pmMid-Afternoon 12pm-5pmEarly Evening 5pm-8pmLate Evening 8pm-10pm

    What days are you available to train?

    Do you have a preference for the gender of your trainer?

    By how much would you like to change your current weight?

    Service Purchased:

    Client Acknowledgement and Assumption of Risk and Full Release from Liability for TotalBodyFit LLC:

    Client acknowledges that these physical activities involves the inherent risk of physical injury or other damages including but not limited to heart attacks, muscle strains, pulls or tears, and any other illness or injury caused occurring during or after client’s participation in the therapy. Client further acknowledges that such risks include but are not limited to injuries caused by the negligence of the therapist or other person, defective or improperly used equipment, slip and fall by client, or an unknown health problem of the client. Client affirms that client is in good physical condition and does not suffer from any disability that would prevent or limit participation in the therapy. Client agrees that it is the responsibility of client to seek competent medical or other professional advice regarding any concerns or activities. By signing the agreement, client asserts that he or she is capable of participations in the physical activities.

    Notice: Client, on behalf of client, his or her heirs, assigns and next of kin agree to fully release TotalBodyFit LLC (as well as any of its owners, employees, or other authorized agents including independent contractors) from any and all liability, claims, and/or litigation actions that buyer may have for injuries, disability or death or other damages of any kind including but not limited to punitive damages arising out of participation in TotalBodyFit LLC services including but not limited to massage therapy even if caused by the negligence, gross negligence, intentional acts or omissions and/or any other type of fault of TotalBodyFit LLC, its owners, employees, or other authorized agents including independent contractors.

    Enter full name here as your electronic signature and acceptance of above terms:

    Date Signed (required)

    All bookings require 24 hours advance booking and credit card guarantee. A full price of the treatment will be charged to your credit card for appointments that are rescheduled or cancelled less than 24 hours.