Supreme Aesthetics Fitness Coaching

Supreme Aesthetics Fitness Coaching

Client intake form
Client Name

First NameLast Name
Birth Date

MonthDayYear
Date
Phone Number
Format: (000) 000-0000.
Email
example@example.com
Please state if you have current/previous health diseases/issues.
Please state whether you take any medication.
What are your top 2 fitness goals right now?
What has held you back from achieving these goals in the past?
Describe your current eating habits:
Where will you primarily exercise?
(Gym, Home Gym, Both)
Please select the best days you can exercise.
Please select the times you will exercise (this will help with diet plan).
What are your goals for training?
What is your current weight & height?
Use lbs for weight
What are your two favorite foods that you don’t want to have to let go of?
Use lbs for weight
I understand that results require consistency, effort, and communication, and I am committed to the process.
Should be Empty: