New Client Intake & Waiver · Starfish Strength

Step 1

About you

First name *

Last name *

Email *

Phone *

Date of birth *

Biological sex (for health calculations)

Mailing address

Emergency contact

Someone we can reach if anything happens during a session.

Contact name *

Relationship

Contact phone *

Your goals

Tell us what you're hoping for — there are no wrong answers.

What brings you to Starfish Strength?

How active are you right now?

Health readiness

A standard pre-exercise screening. Answer honestly — a “yes” doesn't disqualify you; it just helps us train you safely.

Has a doctor ever said you have a heart condition, or that you should only do physical activity supervised by a doctor?

YesNo

Do you feel chest pain or pressure during physical activity, or at rest in the past month?

YesNo

Do you ever lose your balance from dizziness, or have you fainted in the last 12 months?

YesNo

Do you have a bone, joint, or soft-tissue problem that could be made worse by exercise?

YesNo

Do you have a chronic condition (e.g. high blood pressure, diabetes, asthma, thyroid, kidney) we should know about?

YesNo

Are you currently taking any prescription medication, especially for your heart or blood pressure?

YesNo

Are you currently pregnant, or have you given birth in the last 6 months?

YesNo

Is there any other reason a healthcare provider has advised you to limit physical activity?

YesNo

Health history details

Optional

Photo & video release Optional

Nancy sometimes captures photos, video, and audio during sessions and for content on YouTube and social media. This part is completely optional — your answer has no effect on your training, and you can change your mind in writing anytime.

Yes — I give Starfish Strength permission to record and use photos, video, and audio of me in its content, website, and marketing, without compensation. I understand I can withdraw this permission at any time.

Prefer to keep your sessions private? Just leave this unchecked — that's perfectly fine. 🌟