Client Intake Form Template for Injury Prevention & Prehab

Use in FirstRep form

Personal Information

Collecting basic personal information helps tailor prehab programs to individual needs.

Aa Full Name *

Enter your full name

# Age *

Enter your age

Aa Contact Information *

Enter your email or phone number

Medical History

Understanding your medical history is crucial for designing a safe prehab program.

Y/N Do you have any previous injuries? *

... List any current medical conditions

e.g., diabetes, hypertension

Y/N Have you ever undergone physical therapy? *

Activity Level

Assessing your activity level helps in programming appropriate prehab exercises.

v Current Exercise Frequency *

vv Type of Activities Performed *

Goals and Concerns

Identifying your goals and concerns will help focus the prehab program effectively.

... What are your primary fitness goals? *

e.g., improve strength, prevent injury

... Do you have any specific concerns about injuries?

e.g., recurring knee pain

Lifestyle Factors

Lifestyle factors can significantly impact your recovery and injury prevention.

Aa Occupation

Enter your job title or occupation

Y/N Do you have a sedentary lifestyle? *

# How many hours do you sleep on average? *

Enter hours of sleep

Referral and Liability

Understanding when to refer to a PT and addressing liability concerns is essential for trainers.

Y/N Are you currently seeing a physical therapist? *

Y/N Do you understand the importance of prehab? *

Why Use This Template

Tailored Programs

Using this form helps create personalized prehab programs that address individual concerns.

Enhanced Safety

Gathering medical history and current conditions enhances client safety during workouts.

How to Use

Distribute this form to clients before their first session for effective program planning.

Review the completed form with clients to clarify any concerns or goals.

Customization Tips

Add specific injury prevention exercises relevant to your clientele.
Include additional questions tailored to your training style.
Personalize the form's language to match your brand's voice.

Build and send injury prevention & prehab templates digitally with FirstRep. Free for up to 3 clients.

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Frequently Asked Questions

What is prehab?

Prehab refers to preventive rehabilitation exercises aimed at avoiding injuries before they occur.

How often should I participate in prehab exercises?

It's recommended to incorporate prehab exercises into your routine 2-3 times a week.