Form

PARAMOUNT PHYSIQUE

Client Intake Form
*** IN REGARDS TO YOUR CONTACT INFORMATION***I will not be spamming you. The reason I ask for your social media is so we can connect on a further level! I ask for your home address because I may send you a few things in the future! And I promise you will want what I send you. :)

Please answer best to your ability. Any information you don’t know, it’s no problem, we’ll figure it out together!
Date*

MonthDayYear
Date
Name*

First NameLast Name
Age & Birthday *
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Facebook *
Instagram *
Height INCHES OR CM*
Weight LBS OR KG*
1) How many years have you been training? What is your athletic background?*
2) What is your current training? What programs have you ran in the past if any? Types of exercises, sets, reps, how many days on and off? Be specific. *
3) Current diet: Protein, Carbohydrate, Fat in grams total per day. If not known, then please list a typical day and list types of foods and an estimated amount. Also times when eating and how many times per day. *
4) Please list current cardio per week. How many times, duration of each session and calories burned each session if known. *
5) Current Supplements if any.*
6) Do you have any pre-existing medical conditions and/or injuries? *
7) What are your GOALS? (Goal weight, goal strengths, goal bodyfat, etc) *
8. What is your current 1-Rep Max or estimated? LBS OR KG. If unknown, write your current Best Set: Weight x reps) for:Squat:Benchpress:Deadlift:Maxes for other Lifts:*
9. What are your current measurements? (INCHES OR CM)Arms Flexed (left, right):Arms Unflexed (left, right):Shoulder Circumference:Chest (measured under armpits):Waist:Glutes:Legs:Calf:*
10) What does your typical day look like. Wake up time. Bedtime. How active is your job. How much do you walk. Etc. *
11) How many days per week can you commit to training?*
12) Do you have a bad days? If so, what’s a bad day? *
13) Relationship with food? Would you say it’s good or bad? *
Do you have any trigger foods or life triggers in general? *
16)What are you willing to do now to reach your goals?!*
What are you not willing to do to reach your goals? *
What is your support system like? *
20) Have you ever used online coaching before?! What did you like and dislike?! What was missing?! *
21) What are your highest values? Meaning what do you value the most in your life?*
22) Is there anything else you would like to tell me?*
Please let me know if you have any questions and answer to the best of your ability!All information will be confidential unless authorized by yourself to post your result after your badass Transformation! - TMP
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PARAMOUNT PHYSIQUE

*** IN REGARDS TO YOUR CONTACT INFORMATION***I will not be spamming you. The reason I ask for your social media is so we can connect on a further level! I ask for your home address because I may send you a few things in the future! And I promise you will want what I send you. :)

* IN REGARDS TO YOUR CONTACT INFORMATION*I will not be spamming you. The reason I ask for your social media is so we can connect on a further level! I ask for your home address because I may send you a few things in the future! And I promise you will want what I send you. :)