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⚒️ Paterium Intake Form

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✦ Section 1: YOU

What’s your first name?

What’s your email address?

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How old are you?

What’s your height? (In feet/inches or cm)

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What’s your weight? (In lbs or kgs)

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✦ Section 2: YOUR MISSION

What is your primary fitness goal?

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What is your primary fitness goal?

A

Build strength and muscle

B

Lose fat and get leaner

C

Improve conditioning and mobility

D

Become more disciplined and consistent

E

Other

How many days a week can you realistically train?

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How many days a week can you realistically train?

A

2 days

B

3 days

C

4 days

D

5 days

E

6+ days

What type of training do you prefer? (Choose up to 2)

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What type of training do you prefer? (Choose up to 2)

Strength (Weight/Resistance)

Bodyweight / Calisthenics

High Intensity / Conditioning

Boxing / Striking Drills

Mobility / Stretching

I’m not sure

Where will you train?

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Where will you train?

A

At home

B

In a gym

C

Outdoors

D

Mixed

What equipment do you have access to?

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What equipment do you have access to?

Bodyweight only

Kettlebells

Dumbbells

Barbell / Plates

Resistance bands

Pull-up bar

Sandbags / Heavy objects

✦ Section 3: YOUR PATH

What archetype most resonates with you right now?

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What archetype most resonates with you right now?

A

Warrior - I want to fight, sweat, and overcome

B

Guardian - I want to protect, endure, and provide

C

Sage - I want to train my mind and body with purpose

D

Centurion - I want to lead with strength and wisdom

E

I don’t know / Let the system decide

Do you have any injuries or limitations we should consider?

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Do you have any injuries or limitations we should consider?

A

None

B

Yes

Please describe your injury or limitations

What do you want to feel like in 90 days?

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✦ FINAL STEP

Are you ready to begin?

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Are you ready to begin?

A

Yes. Let’s go!

B

Not yet. I’m still gathering myself.