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Thank you for choosing CollabFitness + Yoga for your health. Please select the service(s) you are interested and complete the questionnaire and waivers. You will be sent an invoice upon completion of this form.

The service(s) you select will influence the questions asked. Please be as thorough as possible when responding. Thanks!
The service(s) you select will influence the questions asked. Please be as thorough as possible when responding. Thanks!*

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YOUR INFORMATION
How did you hear about Michelle & CollabFitness + Yoga?*
Name*
First Last
Email*
Date of Birth*
Gender*
- Male
- Female
- Other/Prefer not to say
Cell Phone*
Address*
Street Address City State / Province / Region ZIP / Postal Code
May we text appointment confirmations to you?*
- Yes
- No
May we send you promotional communications?*
- Yes
- No
Emergency Contact Name*
First Last
Emergency Contact Phone*
Height*
Weight*
Please agree to the terms and conditions of the CollabFitness.com website and all services with CollabFitness, LLC*
Our services and products are not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. If you think you may have a medical emergency, call your doctor or 911 immediately. CollabFitness, LLC does not recommend or endorse any specific tests, physicians, products, procedures, opinions, or other information that may be mentioned on this website. Reliance on any information provided by Michelle Spore and CollabFitness employees, others appearing on this site at the invitation of Michelle Spore or other visitors to this website is solely at your own risk. Results with this and any program or service may vary. Exercise and proper diet are necessary to achieve and maintain weight loss. Consult your healthcare professional before beginning any diet or fitness regimen and please refer to your healthcare professional with any medical related questions that may arise while training with any CollabFitness programs, products, services, classes and sessions. This product may be discontinued at any time for any reason. I retain the right to refuse services and products on an as-needed basis. If this occurs prior to services and products rendered, the client will receive a refund. By using this form you agree with the storage and handling of your data by this website.

By your acknowledgment, it is understood that: Michelle Spore, is not a registered dietitian or doctor, she CANNOT legally: prescribe diets or supplements to treat medical and clinical conditions; prescribe diets to treat symptoms of medical and clinical conditions; nor diagnose medical conditions.
I agree to the terms and conditions as stated above
Please agree to the waiver of the CollabFitness.com website and all services with CollabFitness, LLC*
INFORMED CONSENT FOR EXERCISE PARTICIPATION I desire to engage voluntarily in an exercise program given by Michelle Spore and CollabFitness, LLC in Redmond, WA. I understand that the activities are designed to place a gradually increasing workload on the body in order to improve overall fitness. I understand that I am responsible for monitoring my own condition throughout my workouts and should any unusual symptoms occur, I will cease my participation and inform the staff of the symptoms. In signing this consent form, I affirm that I have read, accept and understand this form in its entirety and that I understand the nature of exercise. I know that there may be risks associated with fitness classes and willingly accept those possibilities. I know that it is my responsibility to ensure my own safety. I take full responsibility for my own health and safety in participating in the fitness class and to the extent I deem advisable, will consult a physician before participating in any of the activities. I agree to pay all reasonable costs related to the classes and sessions, including any medical costs, building or equipment damage I incur. Fitness results are not guaranteed.

You agree that by participating in physical exercise or training activities, you do so entirely at your own risk. Any recommendation for changes in diet including the use of food supplements, weight reduction and/or body building enhancement products are entirely your responsibility and you should consult a physician prior to undergoing any dietary or food supplement changes. You agree that you are voluntarily participating in these activities and use of these facilities and premises and assume all risks of injury, illness, or death. We are also not responsible for any loss of your personal property including but not limited to your home and all property inside. If in-home a safe, distraction-free space inside your home, clear of debris and clear of other persons is required.

MEDIA RELEASE I hereby acknowledge that all right, title and interest in the video(s), audio recording(s), and or/photographs (aka “multimedia”) in which I have participated being original works belong to CollabFitness (Michelle Spore) and the said multimedia may be used for online and printed promotional and marketing purposes, public and web presentations, and other various electronic media. I hearby release CollabFitness from all claims from which I may now or in the future for compensation of any kind arising out of my participation the the said multimedia and acknowledge that CollabFitness may use my images in such media for promotional and business development purposes.

AGREEMENT AND WAIVER / RELEASE OF LIABILITY In consideration for being allowed to participate in this activity, which I do freely and voluntarily for my own personal benefit, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors and assigns to: 1. Waive, release and discharge from any and all liability to Michelle Spore, their elected and appointed officials, employees, students, agents, and volunteers for my death, disability, personal injury, property damage, or property theft, or actions of any kind which may hereafter accrue to me. 2. Indemnify and hold harmless Michelle Spore, their elected and appointed officials, employees, students, agents, and volunteers, from any and all liabilities or claims made by other individuals or entities as a result of or relating to my participation in this activity. By engaging with CollabFitness services, sessions, classes and products you voluntarily assume all risks related to exposure to COVID-19.

Please note payments to CollabFitness are non-refundable.

I agree to be bound and as a condition of being allowed to participate in exercise classes, sessions and products, I freely signed and agree to this waiver on the date indicated.
I agree to the terms and conditions of the waiver:
Please agree to the CollabFitness Financial and Cancellation Policy:*
CollabFitness accepts cash, credit card or Venmo payments at the beginning of any services rendered or products purchased. All payments for services rendered and products are non-refundable. Payment is due before each session, class or product service begins.

If a service or product is on auto-renewal and/or is subscription-based, you must cancel up to 10 business days (excluding holidays) before your subscription renews to avoid renewal billing. You may submit an email to [email protected] to request the cancellation.

We do not accept insurance to cover fees. For credit card payments, we will provide an invoice receipt after payment is accepted and services are rendered.

The appointments made for you represent a time set aside specifically for you and your instructor/trainer. We value your time and ask that you value ours by giving at least 24 hours’ notice for any cancellations or changes to your appointment.

Clients who fail to provide 24 hours’ notice will be charged a $60.00 fee. This fee is not billable to insurance and is due upon receipt. Clients who cancel or “no show” on three separate occasions will be discharged as a client of CollabFitness and removed from the schedule. In the event that you are discharged from our services, any referring provider will be notified of the reason for discharge.

If you have any questions regarding this policy, please do not hesitate to contact Michelle at: [email protected].
I understand the Financial and Cancellation Policies as described above. I acknowledge that I am financially responsible for any balance due on covered or non-covered services and products:

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HEALTH INFORMATION
Please list any health conditions or injuries that I need to be aware of (please type "none" if there aren't any):*
What is your primary training goal? (select one)*
- Muscle gain
- Fat loss
- Maintenance
- Improved Endurance
- Improved Health
- Sports Specific
- Injury Prevention
What is your fitness/strength level?*
- Beginner
- Intermediate
- Advanced
Do you currently strength train 3x per week?*
- Yes
- No
Please describe your current exercise regimen:*
for example: “I strength train for 20 minutes 3 x / week; “I perform 7 pushups on my knees daily”
Please describe your current strength levels for the following (note: “needing a break” means you stop the exercise when you have reached a reasonable threshold, before the form is compromised. This is your answer.) Write N/A if unable to perform/answer.
Pushups*
How many in 1 minute before needing a break?
Bodyweight Squats*
How many in 1 minute before needing a break?
Glute Bridge*
How many in 1 minute before needing a break?
Row (dumbbell or resistance band)*
How many in 1 minute before needing a break? What is the lbs of resistance used?
Plank (forearms or hands)*
How long can you hold a plank before needing to take a break?
Please indicate the physical activities that you participate in outside of the gym and outside of work & how many days per week and length of time do you do do them?*
for example: hiking, yoga, walking, swimming, running, etc
Which body parts would you like for me to include in your program?*
- Full body with a lower & upper body focus
- Well rounded program (lower body & upper body combined)
- Hip thrust/chin up
- Deadlift/bench press
- Squat/ Military press
- Single leg/DB focused
- Other Preference
Please specify your other preference (type "none" if there aren't any):*
How many days of training a week would you like me to program for you?*
How many private sessions (personal training and/or yoga) would you like to see me for on a monthly basis?*
Do you have time constraints on any of your training days?*
- I have 30 minutes available
- I have 1 hour available
- I have unlimited time available
Where will you be training?*
- No Equipment
- Commercial Gym
- Home Gym
- Other
Please check the equipment you have access to:*
- Select All
- barbells
- dumbbells
- kettlebells
- resistance bands
- cable column
- flat bench
- benches with different angles (flat, incline, decline)
- Hip Thruster
- 45-degree hyperextension
- chin-up bar
- smith machine
- lat pulldown machine
- chest-supported row machine
- gym strength machines
- inverted row apparatus (suspension straps, smith machine, trx)
- lying leg curl machine
- seated hip abduction machine
- trap bar
- leg press
- aerobic step risers
- long resistance bands
- resistance loop or minibands
- ankle weights
- Other
Please feel free to mention which size dumbbells/weight you have available.
Are there any exercises, yoga poses or methods that you absolutely love or would like to get better at:
Are there any exercises or methods you do not enjoy performing or consistently cause pain and/or injury?
What is your normal daily activity level?*
e.g. bike messenger, carpenter
- Sedentary: Spend most of the day sitting (e.g. desk job)
- Lightly Active: Spend a good part of the day on your feet (e.g. teacher, salesperson)
- Active: Spend a good part of the day doing some physical activity (e.g. food server, postal carrier)
- Very Active: Spend most of the day doing heavy physical activity (e.g. bike messenger, carpenter)
What do you do for a living?*
How long have you been practicing yoga? What level would you describe yourself? (Beginner, Lev. 1, 2, 3)*
*I recommend a good yoga mat for your practice.
What are your health and movement goals in the next 3 months? 6 months? 12 months?
3 mos:*
6 mos:
12 mos:

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INJURIES AND SPECIFIC CONDITIONS:
What?
When?
Treatment:
Limitations:
Medications:
Comments
If you are currently under the care of a doctor and/or physical therapist, are you cleared by your doctor to resume exercise? (Note: a doctor's/therapist's note may be required.)*
- Yes
- No
- Not Applicable
Stress Level*
- High
- Medium
- Low
Approximately how many hours of sleep do you get per night?*
Do you smoke cigarettes?*
- Yes
- No
Is there any other information you about the above that you would like to share with Michelle?

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PHYSICAL READINESS
Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?*
- Yes
- No
Do you feel pain in your chest when you do physical activity?*
- Yes
- No
In the past month, have you had chest pain when you were not doing physical activity?*
- Yes
- No
Do you lose your balance because of dizziness or do you ever lose consciousness?*
- Yes
- No
Do you have a bone or joint problem that could be made worse by a change in your physical activity?*
- Yes
- No
Is your doctor currently prescribing drugs for your blood pressure or heart condition?*
- Yes
- No
Do you know of any other reason why you should not do physical activity (or intense physical activity: pregnancy, health reasons, etc)?*
- Yes
- No
If you answered YES to one or more of the above physical readiness questions:
- Talk directly with your doctor BEFORE becoming more physically active. You will need a medical release from your doctor to continue with this program.
If you answered NO honestly to all questions and are new to physical fitness training:
- Start becoming more physically active - begin slowly and build up gradually. This is the safest way to go to ensure efficient and effective physical fitness gains.
- Take part in a fitness appraisal with your doctor - this is an excellent way to determine your basic fitness so that you can plan the best way for you to live actively. It is highly recommended that you have your blood pressure evaluated. If your reading is over 144/94, talk with your doctor before you start becoming much more physically active.
Delay becoming much more active:
- If you are not feeling well because of temporary illness such as cold or fever, wait until you feel better; or if you may be pregnant, talk to your doctor before you start becoming more active.
- If your health changes so that you answer YES to any of the above questions, tell your fitness or health professional. Ask whether you should change your physical activity plan.
**Although Michelle Spore is CPR/AED certified, please be aware we do not have defibrillator onsite for in-person sessions & classes.**

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NUTRITION
Note: You will be required to submit a 3-day nutrition report in this nutrition section. Feel free to begin your tracking today then report back here with your results. See below for details.
What is your primary goal for nutrition?*
- Fat loss
- Muscle gain (training component required)
- Maintenance
- Overall improved health, not concerned with macros tracking
If female, when was the date of your last period?
Date Format: MM slash DD slash YYYY
How many times do you go food shopping per week?*
How many times do you eat out per week (includes restaurants and takeout)?*
How do you approach meal planning?*
- Mainly meal plan/prep, I mostly know what I will eat most meals of the week
- Mainly last-minute decisions, I make a choice of what I eat right before consuming most meals of the week
- A combination of meal planning and last moment decision making
Do you suffer from any of the following?
- Craving certain foods
- Bloating 1 hour after eating
- Binge eating
- Fatigue, sluggishness
- Have trouble falling asleep at night
- Have difficulty waking up in the morning
Below we ask that you report your average daily macronutrient intake for 3 days within the past week. Try to at least 1 weekend day (example: Sunday, Monday, Tuesday, etc). Take the 3 days’ averages and divide by 3!

Macro numbers must be submitted in specific macronutrient amounts (150g protein, 200g carbs, 60g fat; etc) in order for us to have the information needed to begin services. For those tracking in percentages, please take time to convert these to specific gram amounts. Please do not enter "n/a" when filling out your macronutrient intake. There's no need to try to hit certain numbers, just a tracking of what you've been normally consuming. You can use a program such as MyFitnessPal or MyMacros+ and log what you normally eat as you go through your day. A form submitted without an intake will cause a delay in receiving your plan.
Average 3-day protein Intake (g)*
Average 3-day carbohydrate Intake (g)*
Average 3-day fat Intake (g)*
How long have you been at this intake?*
Have you been gaining, losing or maintaining weight at this intake?*
- Losing
- Maintaining
- Gaining
Do you track your food intake using a food scale, by volume, both, or none?*
- Food scale (in grams)
- Volume (cups & ounces)
- Both food scale and volume measures
- Not at this time
Do you account for all food/drink including small bites, sips, tastes, etc when food tracking?*
- Yes
- No
- Sometimes
Do you account for all oils, sauces, fats, dressings and beverage add-in’s when tracking food intake?*
- Yes
- No
- Sometimes
What is your nutritional preference?*
- Higher carbs
- Higher fats
- No preference
What is your weekly intake preference?*
- Lighter eating on weekdays, heavier on the weekends.
- 1 day per week heavier intake.
- Doesn’t matter. Everyday can be the same intake.
Please explain your dieting history, if any:*
Is there any other information that could affect entering into a nutrition coaching relationship with CollabFitness and MIchelle Spore (type "none" if nothing)?*
Please upload 3 pictures for progress photos: Front, Side & Back. These are private and will not be shared.*
Here is a link to help you understand how to take these photos: Front Full Body, Side Full Body, and Back Full Body

Progress picture tips: sports bra and shorts for women (a bikini will also work); for men, shirtless in boxers or shorts. Stay consistent with the same outfit every time you take pictures. Next, find an area of the house that has good lighting. Use the timer feature on the phone/camera, if needed.

Please take front, side/profile, and back of body photos in a relaxed posture..

Each time you take such progress pictures, make sure you do them with the same conditions every time: outfit, lighting, location, time of day, etc.
Drop files here or

Accepted file types: jpg, gif, png.
What is your waist measurement in inches?*
(the narrowest part of your waist - possibly above the navel)*

*Be sure to remember how you measured this each month and try to use the same tape measure each time.

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INFORMED USE
CollabFitness, Michelle Spore, and their agents assume no liability for persons who undertake physical activity. If in doubt after completing this questionnaire, consult your doctor prior to physical activity. NOTE: Physical Readiness questions are being given to a person before he or she participates in a physical activity program or a fitness appraisal, this section may be used for legal or administrative purposes.
I hereby affirm that I have read & understood & answered honestly the above questionnaire. Any questions I had were answered to my full satisfaction.
Client name:*
Signature*
Date*
Date Format: MM slash DD slash YYYY