Initial Client Intake Form
This form does not commit you to treatment. Your information is reviewed by a licensed medical provider.
Full Name
*
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
City & State
Email
example@example.com
Age
*
Sex/Gender
Please Select
Female
Male
Non-binary
Prefer not to say
Other
Height
*
Weight
*
Primary goals (choose up to 3)
*
Fat Loss
Muscle Gain
Hormone Balance
Longevity & Aging Well
Increased Energy & Vitality
Better Sleep & Recovery
Less Anxiety / Stress
Better Libido / Intimacy
More Mental Clarity & Focus
Better Gut Health / Inflammation
Increased Confidence & Body Image
Other
What are your greatest pain points right now? (e.g., fatigue, weight, cravings, focus, stress, etc.)
*
What have you already tried in the past 6–12 months?
Dieting
Exercise Programs
Supplements
Prescription Meds
Peptides
Therapy / Mindset Work
Other
What’s your relationship with food like right now?
Pretty solid
Emotionally driven / reactive
Always hungry or craving
Restrictive or controlled
Unpredictable / varies daily
How would you rate your energy? (1 = exhausted, 10 = energized)
1
2
3
4
5
6
7
8
9
10
How would you rate your sleep quality? (1 = poor, 10 = excellent)
1
2
3
4
5
6
7
8
9
10
Training frequency
None
1–2x/week
3–4x/week
5x+/week
Type of training (if any)
Digestion / Gut symptoms (check all that apply)
Bloating
Irregular BMs
Cramping / Pain
Brain fog
Reflux
None
Are you more overwhelmed or under-stimulated?
Overwhelmed
Under-stimulated
Both
Not sure
What’s the real reason you want this change now?
*
What would success *feel* like in 12 weeks—not just look like?
Any diagnosed conditions or history we should be aware of?
Any prescription meds or hormone therapies currently used?
HORMONE HEALTH SNAPSHOT (HRT / TRT)
Only fill out this section if you are interested in hormone/Testosterone replacement therapy
Assigned sex at birth
Female
Male
Intersex
Prefer not to say
Symptoms
Irregular cycles or menopausal symptoms
Reduced morning erections / drive
Are you currently using hormone therapy or TRT?
Yes
No
If yes, please specify the hormone therapy or TRT used
Have you had hormone labs in the last 12 months?
Yes
No
If yes, please provide copies of your hormone labs
Medical history (check all that apply)
Readiness and understanding
What are you hoping hormone support would help improve most?
Are you currently pregnant, breastfeeding, or trying to conceive?
Yes
No
N/A
Full Armour Fitness is not a licensed physician. We simply allow access to our medical program and network of licensed medical doctors who prescribe any peptides or hormones.
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