Ready to get started?

Fill out our Intake Form & Services Agreement below

First Name *

Last Name *

Email *

Phone *

Address

Street Address

Country

State

City

Postal Code

Date of birth

Shirt Size

What is your gender? *

Height *

Goal Weight

GOAL DATE TO ACHIEVE DESIRED WEIGHT *

IF YOU DO NOT HAVE A DESIRED WEIGHT THAN EXPECTED TIME FRAME TO ACHIEVE DESIRED GOAL

Guesstimated Body Fat Percentage *

Weight *

What are your primary fitness goals? *

Lose Weight

Build Muscle

Improve Cardiovascular Health

Maintenance

Do you have any specific fitness challenges or limitations we should be aware of? *

Are you currently physically active? *

Yes

How many days and what type of physical activity? *

(ie, cardio type and duration/resistance training type and duration)

What time do you typically workout? *

How much sleep do you get a night? *

Do you nap? *

Yes

Do you snore? *

Yes

Please list your medications

Please list your vitamins and/or supplements

Have you had blood work completed recently? *

Yes

If yes, were there any concerns?

Surgeries *

Please list any medical concerns *

Have you ever been diagnosed with a chronic disease or heart conditions? *

Yes

Do you have problems with your joints? *

Yes

If yes, what kind?

Is there any reason you should NOT participate in physical activity? *

Yes

If yes, please explain.

Have you dieted before? *

Yes

If so what type/kind/duration/success/failures

Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor? *

Yes

Do you feel pain in your chest when you do physical activity? *

Yes

In the past month, have you had chest pain when you were not doing physical activity? *

Yes

Do you lose your balance because of dizziness or do you ever lose consciousness? *

Yes

Do you have a bone or joint problem that could be made worse by a change in your physical activity? *

Yes

Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition? *

Yes

List Food Allergies *

List Food Dislikes *

List, in order, the proteins that you like *

List, in order, the fats that you like *

List, in order, the carbs that you like *

What type of workouts do you enjoy? (Check all that apply)

Preferred Contact Method:

How did you hear about us?

Services Agreement

Please read the following policies carefully before agreeing.

Training Policies
• All training services must be paid in full at the time of purchase. No refunds, returns, or exchanges.
• A minimum of 24 hours’ notice is required to cancel or reschedule sessions to retain prepaid sessions.
• For partner or small group training, all participants must reschedule together if one person cancels within the 24-hour window.
• All individuals utilizing training services must be active Empire Gym members.
• Competition prep, meal plans, and programming do not include personal training sessions.
• Training services do not include gym membership.

Meal Plan Policies
• Meal plans are based on a four (4) week period from the date of purchase.
• Meal plans consist of the same foods/meals daily until check-ins, where adjustments may be made.
• Meal plans do not include personal training or gym access.
• Progress photos (body collage) and scale weight must be submitted every Saturday before 7:00 AM.

Programming Policies
• Programming is based on a four (4) week period from the date of purchase.
• Programming is customized based on individual fitness goals.
• Clients must submit 10-second videos of each movement (last set) via WhatsApp for review.
• Programming does not include personal training or gym membership.

Transformation / Competition Prep Policies
• Includes meal planning, programming, and posing guidance (if competing).
• Available in four (4) week or sixteen (16) week options.
• Competitors must submit posing videos once per week (every Saturday before 7:00 AM), beginning 12 weeks prior to competition.
• Does not include personal training or gym access.
• Coach attendance at competitions is not included. Additional fees may apply if requested.

Acknowledgment
By checking the agreement box and signing this form, I confirm that I have read, understand, and agree to all policies outlined above and acknowledge that results require my full participation and consistency.

By checking this box, I agree to be bound by all terms listed above.

By checking this box, I consent to receive marketing and promotional messages including special offers, discounts, new product updates among others from Empire Gym at the phone number provided. Frequency may vary. Message & data rates may apply. Text HELP for assistance, reply STOP to opt out. No mobile information will be shared with third parties/affiliates for marketing/promotional purposes. Information sharing to subcontractors in support services, such as customer service, is permitted.

Please sign. *

Clear

Submission of form is your consent and agreement to and understanding these terms. Services cannot be refunded, transferred, or paused. This agreement is legally binding and enforceable upon submission.

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