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client intake form
please fill out with as much detail and
honesty
with exactly where you're at
right now
!
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Email
*
Your email
name
*
Your answer
today's date
*
Your answer
age
*
Your answer
height
*
Your answer
current weight
*
Your answer
would you like your weight to be different? if so, how?
*
Your answer
what are you having a hard time with that led you to seek out a Health Coach / working together again?
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Your answer
how about movement? are you currently working out? if so, what are you doing and how often?
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Your answer
what kinds of diets or ways of eating have you tried in the past or since we last worked together?
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Your answer
what kinds of foods did you eat growing up?
Your answer
what's a typical day of eating like for you right now?
Your answer
how about a typical DAY in your life right now? what time do you wake up? what's work like? what do you do? kids? commute? bedtime? do you sleep LOL get specific!
*
Your answer
tell me about your goals for 2025! let me hear your HEART -
what would the healthiest version of you in the season you're in accomplish?
Your answer
where did you find me? were you referred by someone? if so, please tell me who!
*
Your answer
is there anything else that would be helpful for me to know? xx
Your answer
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