Fitness & Nutrition Coaching Intake Form

Fitness & Nutrition Coaching Intake Form

Share your goals, training, health, and nutrition details so we can build a personalized plan for you.
Personal Information
Full Name

First NameMiddle NameLast Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Sex

Other
Height
Current Weight
Occupation
Location / Time Zone
Goals
Primary goal
Secondary goals
Why does this goal matter to you?
Target date or event
Target weight, body fat, or performance number
Readiness to commit

1

2

3

4

5

6

7

8

9

10

1 is Not ready, 10 is Fully ready
Training History
Do you currently work out?
Current training program description
Past training experience
What has worked well for you before?
What has not worked well, or why did you stop previous programs?
Preferred training format
Where will you train?
Equipment access

Other
Days per week available to train
Available session length
Exercises you love
Exercises you want to avoid
Health & Medical History
Current or past injuries
Surgeries, chronic conditions, or diagnoses
Cleared by a doctor for exercise?
Current medications or supplements
Allergies
Family history of relevant conditions
Pain during specific movements
Do you experience dizziness, chest pain, or shortness of breath during exercise?
Pregnancy, postpartum, or menstrual cycle considerations
Lifestyle & Recovery
Average Hours of Sleep
Sleep Quality

1

2

3

4

5

6

7

8

9

10

1 is Poor, 10 is Excellent
Stress Level

1

2

3

4

5

6

7

8

9

10

1 is Low, 10 is High
Main Sources of Stress
Occupation Demands
Alcohol Consumption Frequency
Tobacco or Recreational Drug Use
Daily Water Intake
Schedule Consistency
Current Life Stressors Affecting Consistency
Nutrition History
Typical Day of Eating
Food Tracking App
Diets Tried Before

Other
What Worked and What Didn't
Foods You Dislike
Dietary Restrictions

Other
Food Allergies or Intolerances
Meals and Snacks per Day
Who Cooks and Shops in Your Household
Time Available for Meal Prep per Week
How Often Eat Out per Week
Cravings
Caffeine Intake
Alcohol Intake and Willingness to Adjust
Budget Considerations for Food and Supplements
Body Composition & Measurements
Current Weight
Body Measurements (waist, hips, chest, arms, thighs)
Body Fat Percentage (if known)
Recent Significant Weight Changes
Coaching Preferences
Do you prefer detailed explanations or just clear instructions?
How often would you like check-ins?
Preferred communication method
Do you prefer a rigid structured plan or a flexible framework?
What accountability style motivates you best?
Past coaching experience: what did you like or dislike?
What type of coaching are you looking for?
Upcoming travel, holidays, or other disruptions we should plan around
Motivation & Mindset
What has stopped you from reaching this goal before?
What does success look like in 3 months and 12 months?
What are your biggest current obstacles?

Other
How do you typically respond to setbacks?
Anything else your coach should know?
Upload optional supporting documents or photos

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Fitness & Nutrition Coaching Intake Form

Personal Information

Goals

Training History

Health & Medical History

Lifestyle & Recovery

Nutrition History

Body Composition & Measurements

Coaching Preferences

Motivation & Mindset