Duke Health and Fitness Center

Personal Training Intake

Please fill out the form and someone will contact you within the next two business days.


Note: A red asterisk (symbol *) indicates a required field. You cannot continue or submit until you enter or make a selection for a field with an asterisk.


If you have any questions about this form, please contact us by:

  • Email DukeHealthandFitnessCenter@duke.edu
  • Phone 919-919-660-6660


If you experience technical difficulties with this form, please contact Shannon Shurtygin at srs89@duke.edu.

Client Information

How do you like to be contacted?*
Are you a patient at Duke Lifestyle and Weight management with a referral for personal training?*

Please check all that apply!

Optional

Do you have a trainer preference?*

Offering Selection

Please check all that apply!

Select
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Availability

Please select your availability:

(6:00 - 8:00 am)


(8:00 am - 12:00 pm)


(12:00 - 4:00 pm)


(4:00 - 6:30 pm)


Additional Information

What is your membership status with the Duke Health and Fitness Center?*

Optional - Please check all that apply!

Optional

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