Client Intake Form Template for Prenatal & Postnatal Fitness

Use in FirstRep form

Personal Information

Collecting personal details helps tailor fitness programs to individual needs.

Aa Full Name *

Enter your full name

Aa Email Address *

Enter your email

Aa Phone Number *

Enter your phone number

Pregnancy Information

Understanding your pregnancy stage is crucial for safe exercise modifications.

Y/N Are you currently pregnant? *

D Due Date *

Select your due date

v Trimester *

Medical History

Gathering medical history helps ensure exercise safety and effectiveness.

Y/N Have you received medical clearance for exercise? *

... Any pregnancy complications?

Please describe any complications

... Relevant medical conditions

List any relevant medical conditions

Fitness Goals

Identifying your fitness goals helps create a focused workout plan.

vv What are your primary fitness goals? *

# Desired workout frequency per week *

Enter number of sessions

Exercise Experience

Understanding your exercise history helps in designing your fitness regime.

... Previous exercise experience

Describe your past exercise routines

v Current activity level *

Pelvic Floor Health

Assessing pelvic floor health helps in managing diastasis recti and recovery.

Y/N Have you experienced pelvic pain? *

Y/N Have you had diastasis recti screening?

Y/N Any incontinence issues?

Additional Considerations

Addressing any other relevant aspects ensures a holistic approach to fitness.

... Do you have any dietary restrictions?

Please specify any dietary restrictions

... Additional comments or concerns

Any other information you would like to provide

Why Use This Template

Safety First

Ensures that all fitness recommendations are safe and tailored to individual needs.

Personalized Approach

Creates a customized fitness plan based on unique medical and fitness histories.

How to Use

Fill out all sections of the form thoroughly to ensure accurate assessment.

Consult with your healthcare provider if you have any medical concerns before starting exercise.

Customization Tips

Adjust field options based on local medical guidelines.
Include space for personal trainer signature for accountability.
Add a section for partner involvement in the fitness journey.

Build and send prenatal & postnatal fitness templates digitally with FirstRep. Free for up to 3 clients.

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Frequently Asked Questions

What is diastasis recti?

Diastasis recti is the separation of abdominal muscles during pregnancy, which can affect recovery.

How soon can I start exercising after childbirth?

Most women can start gentle exercises within a few days after childbirth, but it's important to get medical clearance first.