Client Intake Application

VicSanityX / Relentless Consistency

Start Your VicSanityX Journey

Medical Disclaimer: Vic Bailey is not a medical provider and does not provide medical advice. VicSanityX Training Solutions provides fitness coaching and general educational information, not medical diagnosis, treatment, or prescriptions. All clients should consult their physician before starting or changing an exercise program, hormone therapy, peptide therapy, supplement, or medication. Do not delay medical care or change prescribed treatment based on our content or coaching. Medical decisions and prescriptions belong with your licensed healthcare provider.

Complete your client intake before your first training consultation. Include units for height and weight. Your answers will be sent to Victor Bailey for review.

Please tell your trainer about new pain, symptoms, or restrictions before training. Only share health information relevant to your training.

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Client Profile & Goals

Date

Full Name(required)

Age

Height

Current Weight (include units)

Goal Weight (include units)

Email(required)

Phone Number

What are your main fitness goals?(required)

Short-term goal (next 8-12 weeks)

Long-term goal (6-12 months)

Why are these goals important to you?

Training & Availability

Lifting experience (beginner / intermediate / advanced)(required)

How many times do you work out each week?

How many days can you commit each week?(required)

What training have you done before? What did or did not work?

Where will you work out? (home, gym, both, other)

What equipment do you have access to?

Time available per session

Preferred training days / times

Exercises you enjoy, dislike, or want to learn

Health, Habits & Starting Point

Prior or current injuries, pain, surgeries, or movement limitations

Health conditions or medications that may affect exercise

Any exercise restrictions or medical clearance advised? (yes / no / unsure)

Typical daily activity (desk, active job, steps, etc.)

Average hours of sleep per night

Current stress level (low / moderate / high)

How would you describe your current eating habits?

What might make it hard to stay consistent? How can I support you?

I agree to send this information to Victor Bailey / VicSanityX Training Solutions for my training consultation and to be contacted about my application.(required)

I understand that Vic Bailey is not a medical provider and does not provide medical advice. I will consult my physician before beginning or changing exercise, hormone or peptide therapy, supplements, or medications.(required)

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