A quick note: This form is not a medical screening and nothing here constitutes medical advice. It's simply a way for me to understand you better so I can build you a program that fits. If you have a medical condition or injury that requires professional oversight, please consult your doctor before starting any new training program.

Section 01

About You

Full name

Email address

How did you hear about this program?

Section 02

Your Goals

What are you hoping to get out of this program? Be as specific as possible. "Get stronger" is a starting point — but what does that look like for you? What will be different in your life when you get there?

Which of these best describes your primary goal? Select all that apply.

Build muscle

Lose body fat

Get stronger

Improve endurance

Move better / feel better

Athletic performance

Build a consistent habit

Other

Is there a specific milestone, event, or date motivating you? Optional — but helpful if there is one.

Section 03

Training Background

How would you describe your current training experience?

New to strength training — I'm starting from scratch Some experience — I've trained before but inconsistently Intermediate — I train regularly and know the basics Advanced — I have a solid foundation and train seriously

How consistent has your training been over the last 6 months?

What does your current or most recent training look like? What are you doing, how often, and what's been working or not working?

Section 04

Equipment & Setup

Where will you primarily be training?

Home Gym Both

What equipment do you have access to? Select all that apply.

Dumbbells

Kettlebells

Barbell + plates

Pull-up bar

Resistance bands

Cable machine

Full gym access

Bench

Squat rack

Section 05

Limitations & Physical Considerations

This section helps me make your program safe and effective for your body. There are no wrong answers — the more honest you are, the better I can support you.

Do you have any current or recurring musculoskeletal issues — joint pain, injuries, or general aches? e.g. lower back tightness, a shoulder that flares up, knee discomfort, a past ankle sprain that still lingers, etc.

Are there specific movements or positions that are uncomfortable or bothersome for you? Think about things like: hands-and-knees bothers your wrists or knees, overhead pressing aggravates your shoulder, deep squats cause knee pain, lying on your stomach is uncomfortable, etc.

Are there any exercises or movements you know you want to avoid or work around? Whether it's due to discomfort, past injury, or just personal preference.

How would you rate your current overall physical comfort day-to-day? 1 = significant pain or limitation most days — 10 = feeling great, no issues

Significant discomfortFeeling great

Section 06

Lifestyle & Scheduling

What days of the week work best for your training sessions? Select all that could work.

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

What time of day do you typically prefer to train?

Morning Midday Evening Varies

What has gotten in the way of consistency for you in the past? Be real with me. Time? Energy? Motivation? Not knowing what to do? Life getting busy?

Section 07

Anything Else?

Is there anything else you want me to know before we get started? This is your space — share whatever feels relevant.

I'll be in touch within 48 hours to get things moving.

✓

You're all set.

Thanks for taking the time to fill this out thoughtfully.
I'll review everything and reach out within 48 hours.

Let's Build Your Foundation.

You're all set.

Ashley Gadelha PT LLC