Health Coaching New Client Form

Health Coaching New Client Form
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Date

MonthDayYear
Date
Height (inches)
Age
Weight (pounds)
Have you tracked macros before?

YesNoSomewhat, but need help
If yes, describe how long and where your current macros are (if known).
If yes, what food tracking app(s) have you used?
During the coaching progress, one way to measure progress is to track your body measurements.

Waist is at the smallest point of your waist, hips are at the largest part around your glutes, chest is right across the breastbone. Please include measurements in inches.
Waist
Hips
Chest
Highest Adult Weight
Lowest Adult Weight
On a scale of 1-10, how consistent would you say you are with your eating habits?
If you are less consistent than you would like to be, what seems to get in the way or knock you off track?
Do you have any known/suspected food intolerances or allergies? If yes, what?
How often do you have a bowel movement?
Do you currently have any digestive system complaints?
On a scale of 1-10, how would you describe your normal appetite/hunger? 1 is never hungry and 10 is always starving.
Do you normally struggle with food cravings?
If yes, what do you normally crave? What do you normally do when you have cravings?
Have you ever noticed any connection between your emotions/stress and your eating habits? If yes, what happens?
How often do you eat to the point of being full or stuffed?

Almost alwaysOftenSometimesRarelyNever
If you've eaten too much, what do you do afterwards? Check all that apply

Try to eat less at next mealsSkip next mealsTry to exercise moreFeel badTry to get back in controlPurge/vomit/laxativeKeep eating - already blown it!Forget about it and go back to normal eating
How often do you skip meals or purposely go a long time without eating?

OftenSometimesNever
How often do you normally make meals at home per day?

01-23-4all meals prepared at home
How often do you normally eat meals in restaurants/cafeterias per week?

01-23-45 or more meals per week
How much sleep do you get in a 24-hour period?
How much water do you drink per day? What other beverages do you drink per day?
Rate your stress level on a scale of 1-10 (1=little, 10=extreme)
Are there any foods you avoid? If so, please list and explain the reason.
How often and how much do you consume alcohol?
Would you prefer a macro plan or meal plan?

Macro planMeal plan
Are you currently taking any physician-prescribed medications? If yes, please list name and reason for taking.
Are you aware of any reason (through your own experience, a doctor's advice, or anything else) that you shouldn't engage in physical activity? If yes, please explain.
During a typical week, what types of activity are you currently engaging in, for how much time, and how often? Briefly describe your current weight lifting routine (if applicable).
Rate your experience with weightlifting.

Beginner: been active less than one monthIntermediate: been consistently active for more than 6 months but less than one yearAdvanced: been active consistently for more than a yearNever weight lifted
If you are interested in a training program, would you be lifting in the gym or at home? If home, what equipment do you have available to you?
How much time can you realistically devote to your workouts? Please explain briefly.
Do you have a step tracking device such as a Fitbit, apple watch, etc?

YesNoNo but I am willing to invest in one
If you track your steps, about how many do you average per day?
Should be Empty:

Health Coaching New Client Form

During the coaching progress, one way to measure progress is to track your body measurements.