Dig Deep Health — Transformation Intake
Answer a few quick questions so Caleb can assess your readiness and route you to the right coaching track.
Your first step toward becoming who you were made to be.
Caleb is a faith-based transformation coach who helps people become who God designed them to be through accountability, identity-based habit change, and biblical stewardship. He is not a certified personal trainer, dietitian, or medical professional, and will connect clients with the right specialist if needed. This form takes about 5–7 minutes and answers are confidential.
Full Name
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Email
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example@example.com
Phone
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Please enter a valid phone number.
Format: (000) 000-0000.
Age
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Occupation and daily environment
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Sitting all day? On your feet? Physical labor? High stress?
Do you have children? What ages?
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Health and Safety Screening
Your safety matters more than your results. Answer honestly, this just helps me know if you need a specialist on your team first.
Diagnosed medical conditions
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None
Diabetes
Heart disease or high blood pressure
Thyroid condition
Autoimmune condition
Asthma or breathing issues
PCOS or hormonal condition
Other
Current injuries chronic pain or physical limitations
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No injuries or pain
Minor aches that do not limit movement
Current injury affecting how I move
Chronic pain I manage daily
I have trouble with basic movements like stairs or standing
Current relationship with body weight
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I am at a healthy weight and want to improve fitness
I want to lose 20 to 60 lbs
I want to lose 60 to 100 plus lbs
I am 300 plus lbs and it feels overwhelming
I struggle with undereating or restricting food
Disordered eating history
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No
I have had periods of binge eating
I have severely restricted food or fasted excessively
I have been diagnosed with an eating disorder
I am currently in recovery
Not sure but my relationship with food feels unhealthy
Currently experiencing
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None of these
Persistent anxiety affecting daily life
Depression or prolonged sadness
High stress or burnout
Low energy or brain fog
Trouble sleeping consistently
Current medications if any
This just helps me understand your situation, I will never advise on medication.
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Your Why and Readiness
What is the real reason you want to transform your health
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Why is now the right time, what triggered this step
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Does faith play a role in your desire to get healthy
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Yes I want to honor God with my body
I am exploring faith and open to it
I am not faith driven but respect the approach
I would prefer to keep faith separate
On a scale of 1 to 10 how ready are you to change your lifestyle right now
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1 is just curious, 5 is I want to but I am scared, 10 is I am all in no matter what
On a scale of 1 to 10 how likely are you to follow through on what we build together
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What scares you about starting this
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What always derails you, pick your top 1 to 2
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Time
Consistency starting strong then fading
All or nothing thinking
Stress
Losing motivation after a few weeks
Not knowing what I am doing
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Current Habits
Current activity level
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Sedentary
Lightly active
Moderately active 2 to 3x per week
Very active 4 plus times per week
Fitness knowledge self rating
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Beginner need guidance on everything
Know the basics need structure and accountability
Know what to do just need consistency
Realistic training days per week
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2 to 3 days
4 to 5 days
6 plus days
Ideal workout length
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20 to 30 minutes
30 to 45 minutes
45 to 60 minutes
60 plus minutes
Equipment access
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Full gym membership
Home gym
Bodyweight only or household items
Limited or no equipment
Describe your current eating pattern
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Meals per day, skipping meals, eating out, snacking
Biggest nutrition challenge
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Overeating at night
Too busy to eat well
Emotional or stress eating
Do not know what is healthy
Eat out too much
Restrict then binge
Portion control
Sleep quality and hours per night
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Current stress level 1 to 10
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Identity and Coaching Fit
What identity do you want to step into
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Not what you want to do, who do you want to become. Example: I am someone who honors God with how I treat my body.
What accountability style works best for you
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Gentle and supportive
Firm but kind
Direct and no BS
Not sure help me figure it out
Preferred check-in frequency
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Daily touchpoints
2 to 3x per week
Weekly
Flexible
Preferred communication method
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Text or iMessage
WhatsApp
Email
Video calls
Whatever you recommend
What do you need most from a coach, pick your top 2
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Someone who believes in me
Structure and a clear plan
Accountability
Education teach me why not just what
Tough love when needed
Patience I am going to mess up
Spiritual encouragement alongside fitness
Anything else I should know that was not covered
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Acknowledgment
Acknowledgment
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By completing this form I understand: Caleb is a transformation coach, not a certified personal trainer, dietitian, or medical professional. All guidance is general wellness information, not medical advice. I should consult my physician before starting a new program. If my situation requires specialized expertise Caleb will connect me with the right professional. I take full responsibility for my health decisions.
Signature
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Date
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Month
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Day
Year
2 digit month, 2 digit day, 4 digit year
Date
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