Coaching Intake Form

Coaching Intake Form

Please complete this form to help tailor your coaching experience. Answer as the questions as honestly as possible.
Personal Information

Tell us about yourself.
Full Name

First NameLast Name
Male or Female
Email Address
example@example.com
Date of Birth

MonthDayYear
Date
Phone Number (Optional)
Please enter a valid phone number.Format: (000) 000-0000.
Physical Stats

Your current body measurements and goals.
Height (please specify units)
Current Weight (lbs)
Bodyfat % (if known)
Goal Weight (you may estimate or describe the look)
Work & Lifestyle

Your daily environment and routines.
Describe your work environment
Typical work hours or schedule
Average daily energy level (1 = Worst, 10 = Best)

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1 is Worst, 10 is Best
Average daily stress level (1 = Worst, 10 = Best)

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1 is Worst, 10 is Best
Main sources of stress
Sleep quality per night (1 = Worst, 10 = Best)

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1 is Worst, 10 is Best
Do you get restful sleep, wake up often to go to toilet, wake up feeling tied?
Typical daily water intake (oz or liters)
Alcohol intake per week (number of drinks)
Do you take any recreational drugs (Judge free zone)
Do you have any diagnosed medical conditions?
Any past injuries or surgeries?
Current aches, pains, or mobility limitations?
Are you currently taking any medications?
Do you have any allergies?
Current supplements or vitamins you take?
Fitness & Activity

Your current fitness habits and experience.
On a scale of 1-10, how would you rate your current fitness level?

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1 is Worst, 10 is Best
Are you currently exercising?
If yes, describe your current routine (days, type, duration)
Have you ever done structured resistance training or a workout program?
What types of training have you done in the past?
Where do you plan to workout?
If training at home, what equipment do you have? (select all that apply)

Other
How many days per week can you commit to exercise?

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2 is , 7 is
How much time can you commit to a workout? (e.g., 30 min, 1 hour)
Describe your current cardio routine or daily steps (if any)
Preferred cardio option
Nutrition & Eating Habits

Share details about your nutrition.
Describe your current eating habits (typical meals, snacks, timing, etc.)
Have you ever tracked calories or macros?
If yes, what app did you use?
Have you followed any diets in the past? (What worked, what didn’t?)
Do you have any dietary preferences or restrictions?
Foods you strongly dislike
How often do you eat out per week?
Are you willing to meal prep?
Would you prefer:

Other
Do you struggle with any of the following? (select all that apply)

Other
Goals & Mindset

Help us understand your motivation and mindset.
What is the best or most worthwhile investment you’ve ever made?
What are your fitness & health goals?
Why are these goals important to you?
What would success look like for you by the end of the year?
What obstacles have held you back in the past?
How confident are you about your body right now? (1 = Worst, 10 = Best)

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1 is Worst, 10 is Best
Do you experience negative self talk about yourself, body, life? Do you suffer from anxiety or depression?
What is one habit or behavior that has most improved your life?
Any upcoming events or life changes during the time we are working together that may affect your routine?
If you could put a billboard anywhere, what would it say?
Is there anything else you think I should know?
Should be Empty:

Coaching Intake Form

Personal Information

Physical Stats

Work & Lifestyle

Fitness & Activity

Nutrition & Eating Habits

Goals & Mindset