Intake Form | Complete West Health & Performance Gym OKC

First Name:

Last Name

Today's Date:

Age:

On a scale of 1-10, how would you rate your overall health and fitness? (i.e. a "holistic view of your performance + lifestyle")

What are some specific goals you have regarding your health and fitness?

What is the motivation behind that goal?

In the past, what have you found to be the hardest part of sticking with any health and fitness program?

What past injuries or limitations do you have that might make your progress unique?

N/A

Shoulder

Elbow

Back/hip

Knee

Ankle

Other

Are you open to coaching around areas of health such as sleep, stress management, and general well-being?

Yes

With any new decision, we love to ask our clients how "willing & able" they are:

I am determined

I am contemplating

I am not sure

What is your timeline to start?

Today

This Month

Next Month

Other

Thank you for contacting us.
We will get back to you as soon as possible.

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1232 North Sara Road, Oklahoma City, Oklahoma 73127, United States

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