FFF Foundations — Client Intake

Full Name

First NameLast Name

Gender

Date of Birth

MonthDayYear

Age

Years

Height

(Ft)' (in)"

Weight

Lbs

What do you do for a living?

What is your activity level at your job?

What does a typical week look like, including shifts, caregiving and commitments that affect training?

How often do you travel?

Please list the physical activities that you participate in outside of the gym and outside of work.

If you have any diagnosed health problems/Allergies, list the condition(s).

If you are on any medications, please list them (optional).

If you have any injuries, please list them.

What additional therapies are being undertaken for the given injury(optional)?

Are you experiencing any stresses or motivational problems?

Do any diseases run in your family?

Are you a current cigarette smoker?

Your current diet could be best characterized as:

Which of the following goals best align with your goals?

What is your goal with your training?

What brings you to FFF Foundations, and why does it matter to you now?

Why?

How many training days per week can you realistically protect during the next six weeks, and how many minutes per session?

How often during the week are you willing to train to reach your goal? (i.e. 3-5, 4-6, 5-7, etc.)

Over the past three months, what exercise have you done? Include activities, days per week, session length and how easy or hard it feels. None currently is welcome.

Please rate your motivational level to do what it takes for reach your goal.

What training have you tried before, with or without a coach? What worked, what did you enjoy, and what made it difficult to continue?

Are you currently exercising regularly (at least 3x per week)?

What does a typical week look like, including shifts, caregiving and commitments that affect training?

Have you trained with an online coach before?

What could make training or recovery difficult during the next six weeks—for example stress, sleep, energy or caregiving?

If yes what kind of training did you do:

What eating habits, dietary preferences or food allergies would be useful for your coach to know?

At what times during the day would you prefer to train?

What diagnosed conditions, allergies or other health considerations should I know about to adapt your coaching? Enter none if none.

What are your expectations of me as your Online Coach?

Do any medications affect your exercise, balance, alertness or recovery, or come with activity instructions? Share relevant details or request a private discussion.

Are you currently in a financial position to invest in yourself with coaching?

Do you currently have pain, an injury, a recent surgery, or a movement limitation? What activities are affected? Enter none if none.

Email

example@example.com

Are you receiving care for this issue? What exercise restrictions or recommendations has your healthcare professional given you?

Phone Number

Area CodePhone Number

What coaching support or accommodations would help you most?

* All the information on this form is correct to the best of my knowledge. I have sought and followed any necessary medical advice. I understand that all the information given will be kept confidential.

Where will you usually train, and what equipment can you reliably access? Include home/gym/outdoors, weights or resistance levels and space limitations. No equipment is fine.

Which days and times usually work for training? What time zone are you in, and when could you complete your weekly check-in?

Can you access Everfit and Skool on a phone or computer?

Any travel during the next six weeks that may affect your schedule or equipment?

Are you pregnant, recently postpartum, or managing another health change that may require exercise adaptations? Share relevant guidance or request a private discussion.

Emergency contact name

First NameLast Name

Emergency contact relationship

Emergency contact phone

Please enter a valid phone number.Format: (000) 000-0000.

This intake helps personalize your six-week FFF Foundations coaching program. Complete health-readiness screening before your movement assessment or first workout.

Complete the official PAR-Q+ at https://eparmedx.com/ and any follow-up it recommends before your capability assessment or first workout. Share the completed screening outcome securely with your coach. Your coach will review any follow-up or activity restrictions before confirming the next step.

Have you completed the linked health-readiness screening and any follow-up it recommends?

If follow-up is indicated, share the screening recommendation and restrictions securely with your coach. If you have not completed screening or need help, contact your coach. You may submit this intake now, but assessment and training must wait for readiness review.

Your coach will provide a separate coaching agreement, exercise participation consent and privacy notice for review before assessment or training begins. Submitting this intake does not replace those documents.

My answers are accurate to the best of my knowledge. I will tell my coach about changes in symptoms, health or activity restrictions.

FFF Foundations — Client Intake

Health readiness