Wolfhound Health – Client Intake Form

This form takes about 10 minutes. Your answers help me build a safe program that fits your goals, schedule and health history, and they're kept confidential.

Fields marked * are required.

About You

Full Name

Date of Birth

Phone

Occupation (optional) Helps me understand how active you are outside training.

Emergency Contact

Relationship

Their Phone

Preferred Contact Method

Text / SMS Phone call Email WhatsApp Coaching site

How did you hear about Wolfhound Health?

Fitness test (CCJA) Friend or referral Instagram / YouTube Google Kijiji Other

Health Screening

Answer honestly. A "yes" doesn't rule you out; it tells me where to be careful.

Height

Weight

Pre-exercise screening

1. Has a doctor ever said you have a heart condition or high blood pressure? Yes No

2. Do you get chest pain at rest, during daily activities or when you exercise? Yes No

3. In the past 12 months, have you lost balance from dizziness or lost consciousness? Yes No

4. Have you been diagnosed with any other chronic condition (e.g. diabetes, asthma, arthritis)? Yes No

5. Do you take prescription medication for a chronic condition? Yes No

6. Do you have a bone, joint or muscle problem that could get worse with exercise? Yes No

7. Has a doctor ever said you should only exercise under medical supervision? Yes No

8. Are you pregnant, or have you given birth in the past 12 months? Yes No

You answered "yes" to at least one question. We'll go through the full PAR-Q+ together at your consultation, and I may ask for clearance from your doctor before we start.

Please explain any "yes" answers

Injuries and Surgeries Past or current, especially back, knees and shoulders. Include any surgery in the last 2 years. Write "None" if none.

Do you have pain right now that limits your activity?

Yes No

Are you currently seeing a physio, chiropractor or doctor for an injury or condition?

Yes No

Who, and for what?

Medications (optional) Especially any that affect heart rate or blood pressure.

Allergies (optional) Note any that need an EpiPen or inhaler.

Goals

Primary Goals Select all that apply.

Pass a Fitness Test Injury Rehabilitation/Return-to-Work/Return-to-Duty Strength Cardiovascular/Stamina Fat Loss Muscle Gain Bodybuilding Prep Athletic Performance General Fitness Other

Your goal

Which test?

Test Date (if booked)

Which test?

Have you attempted this test before?

Yes, passed Yes, did not pass No

Which part of the test is hardest for you? (optional)

Your "Why" What's driving you, and why now?

Past Attempts (optional) What have you tried before, and what got in the way?

Coaching Style Preference

Drill sergeant: push me hard Supportive and encouraging Somewhere in between

Training Background

Where will you train?

Commercial gym Home gym Bodyweight only Other

What equipment do you have?

Experience Level

Beginner (0–1 yrs) Intermediate (1–3 yrs) Advanced (3+ yrs)

Days/week training now

Days/week you can train

Time per session

Preferred training days (optional)

Confidence with compound lifts Squats, deadlifts and presses

1 – Not confident10 – Very confident

1 2 3 4 5 6 7 8 9 10

Recovery

Average sleep per night

Shift work or irregular hours?

Sleep quality

1 – Very poor10 – Excellent

1 2 3 4 5 6 7 8 9 10

Daily stress level

1 – Very low10 – Very high

1 2 3 4 5 6 7 8 9 10

Coaching Package

Every new client starts with a free 30-minute virtual consultation. Packages are per 4-week block; Custom is per session. All prices in CAD, GST included.

15% off

Limited-time offer

For current or retired military, police and firefighters

Applies to your first month (first 4-week block) or your first assessment.

Which tier interests you?

Blueprint $105/ 4 wks Programming only

Custom 4-week program
Delivered in the coaching app
Exercise demo library

Coached $210/ 4 wks Programming and weekly check-ins

Everything in Blueprint
Weekly phone or video check-in
Daily communication with your Kinesiologist/Personal Trainer
Program adjusted as you progress

MOST POPULAR Hybrid $420/ 4 wks Coaching and weekly in-person sessions

Everything in Coached
One in-person session each week
Hands-on injury work and form correction

Custom $75–$105/ session In-person sessions only

60-minute one-on-one sessions
Book as many or as few as you need
Rehab, technique or a full training day

What would you like your sessions to focus on? Rehab, technique or a full training day, how often you'd like to come in, and any timeline.

Not sure yet. Help me choose at my consultation.

Rehab clients with an active injury start on Coached or Hybrid. Test prep candidates: Coached for at least 8 weeks covers your retest window.

Do you qualify for the 15% offer?

Yes, I'm current or retired military, police or a firefighter

Baseline assessment Recommended starting point, so your program is built on real numbers.

Partial Baseline Assessment, $125 Full Baseline Assessment, $210 Not right now

Payment preference Weekly and bi-weekly payments need at least a 1-month commitment.

Weekly Bi-weekly Monthly (per 4-week block) Quarterly, save 10%

Do you have extended health benefits that cover kinesiology?

Yes No Not sure

Best times for your free consultation

Preferred start date (optional)

Anything else I should know? (optional)

Consent & Signature

Session & Payment Policies

Late Arrivals

Sessions start and end at the scheduled time. If you arrive late, your session still ends at the end of the booked hour, and missed time will not be made up or refunded.

Rescheduling & Cancellations

To reschedule or cancel, email quinn@wolfhoundhealth.ca at least 24 hours before your session. Sessions cancelled with less than 24 hours' notice, or missed without notice, are forfeited.

Late Payments

Payment is due by 11:59 p.m. on your scheduled payment date.

Overdue	Result
After the due date	$25 late fee
More than 72 hours past the due date	Additional $50 late fee
60 days with no payment or payment plan arranged	Account sent to a third-party collections agency

Accounts sent to collections may affect your credit score and may lead to legal action.

I have read and agree to the Session & Payment Policies above. * The information above is accurate to the best of my knowledge. I will tell my coach about any changes to my health, injuries or medications. * I understand that exercise carries some risk of injury or a medical event. I will stop and report any pain, dizziness, chest discomfort or unusual shortness of breath right away. * I consent to Wolfhound Health collecting, using and securely storing my personal and health information to assess my fitness and design my program, under Alberta's Personal Information Protection Act. It will not be shared without my consent unless required by law. * Send me occasional training tips and offers by email. I can unsubscribe at any time. (optional)

Signature Type your full name.

Date

I'll reach out within 24 hours to book your free consultation.

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Form received

Thank you. I'll contact you within 24 hours to book your free 30-minute virtual consultation.

Questions in the meantime? Visit wolfhoundhealth.ca.