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One Family Fitness Goal Planning Session & Coaching Intake

Welcome 👋

This form helps us understand your goals, training history, lifestyle, and health, so we can recommend the best coaching and/or body composition service for you.

It takes about 10 minutes to complete.

Your information is confidential and used only for coaching and program design.

Section 1: Your Details

First & Last Name

Date of Birth

Phone Number

Email Address

Mailing Address

Preferred Method of Contact

Preferred Method of Contact

Section 2: Your Goals

What are your top 3 fitness or health goals?

What are your top 3 fitness or health goals?

Other Goals: share details below

What motivated you to start working on these goals now?

How committed are you to achieving these goals?

How committed are you to achieving these goals?
Not verysomewhatAll in

What has stopped you from reaching your goals before? (Select all that apply)

What has stopped you from reaching your goals before? (Select all that apply)

In 3-6 months, what would "success" look like to you?

Section 3:Your Training Background

Where do you primarily workout?

Where do you primarily workout?

What types of workouts have you done before? (Select all that apply)

What types of workouts have you done before? (Select all that apply)

What did you like or dislike about past training?

What are you currently doing for exercise?

What are you currently doing for exercise?

How often do you exercise?

What equipment do you have access to for working out?

Section 4: Your Nutrition & Lifestyle

Nutrition

Do you currently track your nutrition or follow a specific approach?

Do you currently track your nutrition or follow a specific approach?

How many meals do you usually eat per day?

How many meals do you usually eat per day?

Which best describes your current eating habits? (Select all that apply)

Which best describes your current eating habits? (Select all that apply)

Do you have any food allergies, intolerances, or strong preferences?

Do you have any food allergies, intolerances, or strong preferences?

If comfortable sharing, what's a typical day of eating like? (Optional)

Lifestyle

How would you describe your daily activity level outside of the gym?

How would you describe your daily activity level outside of the gym?

How many hours of sleep do usually get per night?

How would you rate your current level of stress?

How would you rate your current level of stress?

Section 5: Your Commitment & Readiness

Which best describes your mindset right now? (select one)

Which best describes your mindset right now? (select one)

What are you willing to work on to reach your goals? (select all that apply)

What are you willing to work on to reach your goals? (select all that apply)

What are you NOT willing to do to achieve your goals?

Section 6: Coaching Options & Discovery

Which services are you interested in? (Select all that apply)

Which services are you interested in? (Select all that apply)

What are you looking for in a coach?

How did you hear about One Family Fitness?

Section 7: Health History, Coaching & Consent

Health History

What medical conditions or injuries have you been diagnosed with (past or present)?

Do you have any current health concerns, pain or injuries that may affect training?

Are you currently taking any medications (prescription or over-the-counter)?

Are you currently taking any medications (prescription or over-the-counter)?

How would you rank your health right now?

How would you rank your health right now?
Not goodSomewhat goodReally good

PAR-Q+

Before beginning training, you must complete the Physical Activity Readiness Questionnaire (PAR Q+).
Download here: https://eparmedx.com/wp-content/uploads/2025/01/PARQPlus2025ImageFile.pdf

Upload Completed PAR-Q here

Health & Liability Disclaimer

Your safety is a priority.

By submitting this form, you acknowledge that:

Participation in exercise and training involves inherent risk.
You are responsible for consulting a qualified healthcare provider before beginning any new fitness or nutrition program.
Coaching services provided by One Family Fitness, Coaches Dino Camire and Jennifer Oleson, are not a substitute for medical advice, diagnosis, or treatment.
You voluntarily assume full responsibility for your health and participation in all training activities.

Coaching Terms (Summary)

Coaching is a monthly service, billed monthly or quarterly and booked quarterly. Everyone must agree to this prior to hiring a coach.

The Quarters run

Q1- Jan 1 to March 31

Q2- April 1 to June 30

Q3- July 1 to Sept 30

Q4- Oct 1 to Dec 31

12 weeks of each quarter will include at least 1 in-person coaching session. Every thirteenth week will include a remote/virtual check-in via the app chat and possibly a video check-in. 

When you register, you commit to 12 weeks of recurring sessions.

There is a 24-hour cancellation policy; missed in-person sessions without sufficient notice will be forfeited. The client still has access to their program and the app chat and will be coached via the app.

Sessions with sufficient notice that need to be rescheduled by the client will be rescheduled based on the trainer's availability for that week, not carried forward. 

You’re committing to a 12-week block, and holidays you take for work, travel, etc., will not result in sessions being refunded, carried forward, or rescheduled. You’ll be coached remotely while away with workouts tailored to your needs and check-ins done to keep you on track. 

You’ll have access to your program, app integrations, interface, and chat as long as you are a coaching client at One Family Fitness.

Enrolling outside a quarter means you'll pay the remainder of the quarter we are in, plus at least one quarter commitment. 

Client Agreement:

Client Agreement:

Client Signature

Signature