Client Intake & Goal Questionnaire

Client Intake & Goal Questionnaire

Client Intake & Goal Questionnaire

Help us create your personalized program! Please answer the following questions honestly. Your answers are confidential and will guide your workouts, habit coaching, and macro guidance.
What are you filling this out for?
- Full Name
  
  First NameLast Name
- Email
  example@example.com
- Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Occupation / daily schedule
- Age
- Height
- Current Weight
  Enter in lbs
- Goal Weight (if applicable)
  Enter in lbs

- What are your main goals over the next 4 months?
  
  Other
- What is your long term goal?
- Why are these goals important to you?
  Why do you want to achieve these goals?
- How would achieving these goals make you feel?

- Have you followed a workout program before?
- What has worked well for you in the past?
- What hasn't worked for you?
- Are you currently working out? If so, what does that look like?

- Have you tracked macros or calories before?
- Describe your current eating habits:
- Do you follow any specific diet? (If yes, explain)
- Do you struggle with:
  
  Other
- Any foods you avoid or allergies?

- Do you have any current or past injuries or physical limitations?
  Please include location, severity, and anything that aggravates them.
- Have you had any surgeries?
  If yes, please list surgery type and date.
- Any medical conditions I should be aware of? (e.g., high blood pressure, diabetes, joint issues, etc.)
- Are you cleared for exercise?

- What do you feel has held you back in the past?
- On a scale of 1-10, how committed are you right now?
- What type of support helps you most?

- Photo Upload
  
  This section is optional but highly recommended for progress tracking. You can upload:
  • Front, side, and back photos
  • Current body measurements
  
  Please wear fitted clothing and take photos in a well-lit area with a plain background. Measurements can be in inches or centimeters.
  
  These are for your progress tracking only and will be kept private and secure. You can update them anytime throughout your program.
- File Upload
  
  Upload Photos (Front, Side, Back)
  Cancelof
- Body Measurements
  
  Instructions: Enter your measurements in inches or centimeters. Leave blank if you’re not comfortable.
- Waist
  Measure at narrowest point
- Hips
  Measure at widest point
- Chest / Bust
  Measure across fullest point
- Arms
  Measure around the fullest part of upper arm
- Thighs
  Measure around the fullest part
- Optional Comment / Notes
  Use space to note anything you want me to know about your measurements, photos, or progress. For example: soreness, mobility issues, or past injuries affecting form.
- Body Fat % and Skeletal Muscle Mass DXA, Inbody, etc.
  
  If you track body fat % or skeletal muscle mass, you can update them here. If not, just skip. Tracking is optional and helps monitor trends over time.
- Body Fat %
  Enter percentage
- Skeletal Muscle Mass
  Enter in lbs

- What are you expecting from me as your coach?
- What does success look like to you in this program?
- Is there anything else you want me to know?
Should be Empty: