THE MOMENTUM BLUEPRINT | NEW CLIENT INTAKE
WELCOME TO THE MOMENTUM BLUEPRINT | New Client Intake. You have been accepted for coaching. This intake gives me the detail I need to build your coaching setup properly. Complete it as accurately as you can. You do not need perfect answers, just honest ones. Please only complete this form if Tazz has sent you this link after accepting your Expression of Interest.
What’s your full name?
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First Name
Last Name
How old are you?
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I confirm I am 18 years of age or older.
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I confirm
What’s your email address?
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example@example.com
What do you do for work, and what do your typical work hours look like?
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How many hours of sleep do you usually get each night?
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Less than 5 hours
5 to 6 hours
6 to 7 hours
7 to 8 hours
8+ hours
What is your current height?
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What is your current weight?
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SECTION 2: YOUR GOALS
What would you like to achieve by your Week 12 Blueprint Review?
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Where would you like your health and fitness to be 12 months from now?
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What is your main goal right now?
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Lose body fat
Build muscle
Get stronger
Improve fitness
Improve health
Improve energy
Build better habits
Feel better physically
Improve confidence
Get back into training
Other
Why is making this change important to you right now?
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SECTION 3: TRAINING
How motivated are you to make a change right now?
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If you are currently training, what are you doing?
Where will you usually train, and what equipment do you have access to?
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Are you currently training?
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No
Occasionally
1 to 2 times per week
3 to 4 times per week
5+ times per week
How many days per week can you realistically train?
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2 days
3 days
4 days
5 days
6+ days
Are there any exercises or types of training you dislike?
If yes, please explain.
Is there any health or medical information, injury, pain, condition or professional advice that may affect your ability to train safely?
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No
Yes
Not sure
How much time can you realistically give each training session?
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Around 30 minutes
Around 45 minutes
Around 60 minutes
Around 75 minutes
90+ minutes
How experienced are you with strength or weight training?
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Complete beginner
Beginner
Some experience
Intermediate
Advanced
What types of exercise do you enjoy?
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Weight training
Machines
Bodyweight training
Walking
Running
Cycling
Swimming
Group fitness
Sport
HIIT
Circuit training
I do not really enjoy exercise yet
Other
Other
SECTION 4: FOOD & NUTRITION
What is your biggest training challenge right now?
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Getting started
Staying consistent
Knowing what exercises to do
Knowing how hard to train
Finding time
Motivation
Progress has stalled
Confidence in the gym
Injuries or pain
Other
Other
Roughly how many steps do you average each day?
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Under 3,000
3,000 to 5,000
5,000 to 7,500
7,500 to 10,000
10,000+
I do not know
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How many meals do you normally eat each day?
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1
2
3
4
5+
It varies a lot
Walk me through what you normally eat and drink on a typical day.
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What is your biggest nutrition struggle right now?
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Portion sizes
Snacking
Takeaway
Eating out
Alcohol
Sweet foods
Late-night eating
Emotional eating
Binge eating
Not eating enough protein
Not eating enough fruit or vegetables
Meal preparation
Lack of routine
Weekends
I do not know what to eat
Other
SECTION 5: HABITS, LIFESTYLE & COACHING
How would you rate your current nutrition?
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1
2
3
4
Best
5
1 is , 5 is Best
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Are there any foods you cannot eat, do not eat or strongly dislike?
What foods do you really enjoy and would like included where possible?
Have you tracked food or followed nutrition plans before? What worked well, and what didn’t?
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Outside of training and nutrition, what is currently making it hardest for you to stay healthy?
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Poor sleep
Stress
Work
Lack of routine
Family commitments
Alcohol
Screen time
Low energy
Poor time management
Lack of motivation
Mental overload
Nothing major
Other
How consistent would you say you are with healthy habits?
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Very inconsistent
1
2
3
4
5
6
7
8
9
Extremely consistent
10
1 is Very inconsistent, 10 is Extremely consistent
What coaching style tends to get the best out of you?
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Direct and firm
Supportive and encouraging
Highly structured
Educational, I like understanding why
A mix of all of these
I am not sure yet
How much accountability do you want?
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Light touch, give me the plan and let me run with it
Regular check-ins
Strong accountability
Very strong accountability, call me out when I am slipping
What should I be able to expect from you?
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Is there anything else you think I should know before we start? If you use Instagram, add your @handle here too.
OPTIONAL SECTION 6: STARTING FITNESS BASELINE
These measurements give us a starting point so we can track progress. Only complete what you are comfortable providing.
Waist measurement
Want support beyond training and nutrition? This section is completely optional and can be skipped.
How would you rate your current financial situation?
Causing significant stress
1
2
3
4
5
6
7
8
9
Very comfortable
10
1 is Causing significant stress, 10 is Very comfortable
What is your biggest financial stress or concern right now?
Cost of living
Debt
Overspending
Not saving enough
Income
Housing
Gambling
Lack of financial knowledge
No major financial stress
Other
Other
What is your biggest financial goal right now?
Are there any spending or money habits you would like to improve?
SECTION 7: FINAL DETAILS & CONFIRMATIONS
I confirm the information I have provided is accurate to the best of my knowledge.
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I confirm
I understand The Momentum Blueprint provides general fitness and nutrition coaching and is not medical, physiotherapy or dietetic care.
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I agree
I will tell Tazz if an injury, pain, health condition or other circumstance changes in a way that may affect training.
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I agree
SECTION 7: MONEY HABITS & LIFESTYLE
Thanks for completing your Momentum intake. This helps build your starting plan and review progress at Week 12.
What has stopped you in the past or normally throws you off track, and what tends to happen when it does?
What do you need most from me as your coach?
I understand I should seek advice from an appropriately qualified health professional where needed.
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I agree
Current strength levels or key lifts
How would you rate your current fitness or conditioning?
Very low
Below average
Average
Good
Very good
Not sure
Progress photos
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