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New Client Intake Form
Welcome! Please answer the following questions with as much detail as possible. They will help me tailor your training and nutrition program specifically to your needs.
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Todays Date
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Name (Fist & Last Name)
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Your answer
Phone Number
Your answer
Email
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Your answer
Mailing Address (Every so often I like to send my clients gifts)
Your answer
Height
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Your answer
Current Weight
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Your answer
Age & Birthday
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Your answer
What Services are you interested in?
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Small Group Training (4-6 people per session. Progressive training)
Semi-Private Personal Training (2-3 people per session. Personalized training)
Nutritional Guidance
Required
Describe your fitness goals in detail (lose fat, health & longevity, build muscle, improve strength, improve performance, etc.)
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Your answer
Why do you want to achieve these goals?
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Your answer
What challenges are holding you back (or might hold you back) from reaching these goals?
Your answer
Do you have a specific time frame in which you want to achieve these goals by? Please give me details.
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Your answer
What is your current exercise/ fitness level? How many times a week do you workout & what do those workouts consist of? (Cardio, lifting weights, walking, etc.)
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Your answer
How many days can you dedicate to training per week? Take into account your daily obligations and be realistic with how much time you can dedicate to your training.
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Your answer
Do you have any current or pre-existing injuries, aches, medical conditions, or pains? (e.g. arthritis, diabetes, high blood pressure, fractures, etc.)
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Your answer
Are you currently taking any medications that might impact your fitness & nutrition goals? Please list the medications and if you experience any side effects from these.
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Your answer
Please describe your current diet and eating regimen (breakfast, lunch, dinner, snacks, drinks)
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Your answer
Do you smoke or chew tobacco? If so, how often?
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Your answer
Do you drink alcoholic beverages? If so, how often?
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Your answer
Have you tried any diets in the pasts? What did you like or not like about them?
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Your answer
Do you have any food allergies or intolerances?
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Your answer
How much water do you drink a day?
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Your answer
Have you counted Macros in the past? Did you find this helpful or stressful?
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Your answer
How many caffeinated drinks do you have per day?
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Your answer
How many hours do you typically sleep per night?
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Your answer
How committed are you to achieving your goals?
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Eh...
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I'm 100% in! Let's do this!
How did you hear about US?
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Facebook/ Meta
Instagram
Website
Google
Friend/ Coworker, etc.
Other
If you were referred by a friend, please state their name below.
If you selected 'Other' above, please describe below.
Your answer
Is there anything else you need or would like your coach to know?
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Your answer
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