WPT Client Intake Form
SECTION 1 — CLIENT INFORMATION
Full Legal Name
*
Date of Birth
*
Email Address
*
Phone Number
SECTION 2 — GOALS AND TRAINING BACKGROUND
What option did you select?
*
Coaching
Program Design
Primary Goals
Strength
Muscle Building
Speed
Fat Loss
Athletic Performance
Movement Quality
Post Partum Fitness
Competition Prep
Describe your goal and what success looks like in 12 weeks
*
What has stopped you from reaching this goal in the past?
List some of your most hated and favorite exercises and training methods
*
" I like super sets" " I only do functional training" "I hate doing barbell movements"
Do you have a specific event or deadline you are working toward?
Training experience level
*
Describe your current training routine
*
What types of training have you done in the past
SECTION 3 — Nutrition Screening
What is your primary nutrition goal?
What is your current diet?
Have you tried to change your diet? If yes, what happened?
Have you ever tracked calories? If yes, how so?
Do you have any eating disorders?
What does a typical eating day look like?
Meals/Day, cooked-purchased
List your favorite and hated foods
Do you have any allergies, religious restrictions or intolerances?
Do you have a grocery budget?
SECTION 4 — PAR-Q HEALTH SCREENING
These are standard PAR-Q questions. Answer Yes or No honestly, and if you answer Yes to any item, you should consult a physician before starting physical activity.
Has a doctor ever said you have a heart condition and should only do activity recommended by a doctor
*
Yes
No
Do you feel chest pain during physical activity
*
Yes
No
In the past month did you have chest pain when not exercising
*
Yes
No
Do you lose balance due to dizziness or ever lose consciousness
*
Yes
No
Do you have a bone or joint problem that could worsen with exercise
*
Yes
No
Is a doctor currently prescribing drugs for blood pressure or heart condition
*
Yes
No
Do you know of any other reason you should not do physical activity
*
Yes
No
Where will you be training and what equipment do you have access to
SECTION 5 — FITNESS ASSESSMENT
Current injuries, pain, or physical limitations
Chronic health conditions
*
Current medications that may affect exercise or recovery
*
Average hours of sleep per night
Stress level on a 1-10 scale
Use of alcohol tobacco or nicotine and any supplements
Preferred check-in method and how they respond best to coaching feedback
Any exercises or equipment to avoid
How many days per week and how long per session can you train
Skill Level For Squat
Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
Skill Level For Dead Lift
Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
Skill Level For Bench
Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
Are you currently pregnant or postpartum?
*
Are you between the ages of 15 and 69?
yes
no
Is there anything else related to your health history your coach should know before building your program?
Occupation and how physically demanding it is
PAR-Q Declaration - I have read and honestly completed this health screening questionnaire. I understand that if I answered YES to any health-related questions above, I should consult my physician before beginning a physical activity program. I confirm that all information provided is accurate to the best of my knowledge. If yes type your full name below.
*
How would you prefer to receive weekly check-ins and how do you respond best to coaching feedback?
Optional front photo upload
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Optional side photo upload
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Optional back photo upload
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Is there anything else you want your coach to know about you, your goals, or your situation?
How did you hear about Wilson Precision Training?
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