Intake Form
What is your name?
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First Name
Last Name
What is your email address?
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example@example.com
What is your phone number?
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Area Code
Phone Number
Age
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Your Weight
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Body Fat %
List current injuries, aches, and pains.
Why are you looking for a coach?
What is your current fitness situation?
What are your main health and fitness goals?
Why are these your goals?
How long would it take for you to accomplish this on your own?
Do you want to sustain your goal after you achieve it?
On a scale of 1-10, a 1 being you’re not serious at all, a 10 meaning you’re extremely serious and looking to make a long lasting life-style change, where would you rank yourself?
Why did you choose the number you chose, meaning…If you are a 10, why are you a 10 ?If you were below anything other than a 10, why did you not choose 10?
You already know it’s not easy to lose weight/see results, will you take my recommendations and do what I ask to help you reach your goal?
Why are you taking action now?
Why do you think you’ll succeed this time?
My average client loses 10 lbs of fat and builds 5-8 lbs of muscle or more with me in the first 3 months, are you ok with this?
Have you struggled losing weight or seeing your desired results in the past?
Have you struggled with maintaining a self directed fitness program in the past?
Do you think you’d lose weight faster with daily accountability?
Do you think you would see results faster with a fitness expert helping you along the way?
Is it more important that you see results quickly or that it’s permanent?
Going forward, how many days per week can you 100% commit to working out?
What days and times generally work best for you to workout?
Please list any injuries, aches, and pains you have currently.
Why did you reach out to me?
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