Intake Form Client Intake Form Client Intake Form Please complete the following form before your first session with BodyFit LA. Contact Information Full Name Date of Birth Gender Phone Number Email Emergency Contact Name Emergency Contact Phone Primary Physician Physician Phone Health History Please list any past or present conditions, injuries, medications, or relevant information: Consent By checking this box and submitting this form, you agree to the Coaching Agreement and Release of Liability, Code of Conduct, and Acknowledgement of Risks without a Medical Release Form provided by BodyFit LA, LLC. You acknowledge there may be service charge fees depending on the form of payment. I agree to the terms and conditions stated above. Type Your Full Name as Signature Date Submit
