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New Online Training Client Intake Form

Welcome! We're glad you're considering training with us. Let's start with the basics.

Name?

Gender?

Gender?
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B

Email

Age

Height (feet & inches. 5 feet, 1 inch, would be entered 5.1)

Weight (pounds)

Let's talk about your goals:

What are your goals?

What are your goals?

What are your health & fitness goals? Be as specific as possible.

Sleep

How many hours of sleep do you get nightly? Link data from a fitness tracker here:

Are you sleepy and tired during the day? Are you refreshed or not when you wake up?

Do you have a TV, laptop, phone, or other electronics in the bedroom? What do you do in the bedroom? When do you get up and go to bed?

Activity level

What is your current exercise routine? Please include as much detail as possible including strength levels if you can:

Do you have a warm-up, cool-down, and mobility routine? If so detail it here:

Detail your weekly physical activities (walks, fitness classes, etc):

How many steps do you walk daily on average? Please attach the average from a fitness tracker here:

What do you enjoy in training? Heavy weights? Switching exercises? Intensity? Etc. Be specific here.

What training routines and methods have you tried? Did you like any of them or dislike any of them?

What fitness equipment and gadgets do you use if any? Do you have access to a gym? If so does it have dumbbells & power racks?

Nutrition

Explain your current diet in as much detail as possible (macronutrient breakdown, daily foods, timing of food intake, water):

List any allergies or food restrictions you have:

What drugs do you take? (alcohol, marijuana, steroids, etc). How often and what dosage?

What supplements do you take? What dosage and amount?

Where do you struggle in exercise and nutrition?

What's your health like?

What are the stressors in your life? For each stressor, label 1-10 how stressful it is for you (with 10 being the worst stressor)

What, if any, significant medical condition(s) and/or injuries have you been diagnosed with (currently or in the past)?

What, if any, medications, either over-the-counter or prescriptive, are you taking?

Provide a link to a comprehensive metabolic panel here:

Anything else that we should know?

What are your expectations for this experience?

Disclaimer

You are responsible for working directly with your healthcare provider before, during, and after seeking nutrition, fitness, and behavior change help. Any information provided by us is not to be followed without prior approval from your doctor. If you choose to move forward with the information provided without your doctor's approval, you agree to accept full responsibility for your decision.
By clicking the yes button below, you're agreeing to the disclaimer and that all of the information you've provided above is accurate and up to date to the best of your knowledge.
Untitled multiple choice field
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B

Thank you! We will review your application and get back to you.