JM High Performance Prospective Client Intake Form

1
Name* This field is required.
First Name
Last Name
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Email* This field is required.
example@example.com
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Phone Number* This field is required.
Please enter a valid phone number.
4
What are your top 1-3 fitness goals right now?* This field is required.
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Why are these goals important to you?* This field is required.
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How long have you been working toward them?* This field is required.
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What's held you back from reaching them in the past?* This field is required.
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What would success look like for you in 3 months? In 12 months?* This field is required.
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What is your current weekly workout routine?* This field is required.
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Do you currently follow a specific program/coach?* This field is required.
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What types of training do you enjoy?* This field is required.
Bodybuilding/aesthetics
Powerlifting
Olympic Weightlifting
High-intensity interval training
Cardio
Team/Solo Sports
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What types of training or exercises do you dislike/want to avoid?* This field is required.
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Do you have experience tracking your workouts (with an app, in your notes, or a Google Sheet)?* This field is required.
YESNO
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Do you currently follow a nutrition plan or style of eating? Please briefly describe.* This field is required.
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Do you have any dietary restrictions or preferences?* This field is required.
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How many meals do you typically eat per day?* This field is required.
1 - 2 large meals
1 - 3 moderate sized meals
3 - 5 smaller meals
I'm inconsistent with my eating
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Do you drink alcohol? If so, how often?* This field is required.
I don't drink
I drink occasionally (once every few months)
I drink 1 - 3 drinks a week
I drink over 3 drinks a week
18
How many hours of sleep do you get on an average night?* This field is required.
Less than 6 hours
6-8 hours
It's pretty inconsistent
19
What is your current stress level from 1-10? What are your top stressors (school, work, travel, etc)?* This field is required.
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Do you have any medical conditions or injuries that I should know about that would affect your physical performance?* This field is required.
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Are you currently taking any medications or supplements?* This field is required.
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How committed are you to achieving your goals from 1-10?* This field is required.
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What level of support do you feel you need from me as a coach?* This field is required.
I'm confident and I just need some guidance and feedback (experienced)
I have some experience with training and want to take it to the next level (some experience)
I'm intimidated by getting started on my journey (beginner)
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What would make this coaching experience a success for you?* This field is required.
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Are you looking for:* This field is required.
A custom training program and feedback
A custom training program, feedback, and check-ins
A custom training program, feedback, check-ins, and nutrition guidance
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Are you ready to start in the next 7 days? If not, what's your timeline?* This field is required.
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