Client Intake Form

Dear Client,

Thank you for choosing Vitality Empower for your training and coaching journey. I’m honored to be part of your mission to achieve your fitness goals and create a healthier, more empowered lifestyle.

Based on our previous conversation, I kindly ask that you submit your weight updates every 2 weeks, and progress photos every 4–6 weeks. This allows me to fine-tune your plan and ensure you’re getting the most effective, personalized coaching possible.

You can reach me anytime by email — I aim to respond within 24 hours, Monday through Friday between 6 AM PST and 6 PM EST. While I’m unavailable on weekends, any messages sent late Friday will be answered the following Monday.

In case of an urgent need, feel free to send a text to the contact number provided. I’ll respond as quickly as I can.

To get started, please complete the form below. Your detailed responses will help me create a plan tailored to your unique goals, preferences, and lifestyle.

Thank you again for choosing Vitality Empower. I look forward to helping you unlock your full potential.

To your success,
John Winkleman
Your Strength Strategis

Name

First NameLast Name

Phone Number

Area CodePhone Number

Email

example@example.com

Do you currently have a coach or trainer?

YesNO

What is your coach's full name

Goals and Timeline

1. Please provide specific details about your fitness goals. For instance, you can mention if you would like to achieve a leaner physique, improve overall well-being, increase running speed, enhance strength, build more muscle mass, focus on developing a larger booty, reduce leg size, or aim for broader shoulders. Feel free to include any other specific goals you have in mind. Being clear and specific about your desired outcomes will help me tailor a personalized training/coaching program to meet your needs effectively.

2. Are you planning to attend any special events or are you embarking on a fitness journey to achieve an amazing shape? This could be for occasions such as weddings, vacations, or any other significant event. If you are, could you kindly provide the date or dates of the event? This information will help me tailor a program that aligns with your goals and timeline.

Health & Restrictions

3. Prior starting your fitness journey with Vitality Empower, it is important for us to be aware of any injuries or restrictions that may impact your fitness goals. This information will help us tailor a program that is safe and effective for you. If you decide to hire our services, we will provide you with a health history questionnaire to gather this information in detail. Your honest and thorough responses will enable us to create a personalized training plan that takes into account any limitations or considerations.

4. Please indicate the amount of time you can allocate each week towards your fitness goals

5. Please rate your current fitness level on a scale of 1 to 10, with 10 being the highest. This will help us better understand your current physical condition and tailor a suitable fitness program for you. Your honest response is greatly appreciated

Current Lifestyle

6. Please provide a detailed description of your current fitness program. For instance, you can include information such as the frequency and types of exercises you engage in.

7. Please provide a detailed description of your current food program. It would be helpful if you could outline what you typically eat on a daily basis as part of your normal food program. This will allow us to gain a better understanding of your dietary habits and make appropriate recommendations or adjustments as needed. Thank you.

8. Which diet programs have you experimented with? Additionally, which diet programs have you achieved success with? Furthermore, among these diet programs, which ones did you strictly adhere to as per their intended guidelines?

Medical Info

9. Are you currently taking any medications that we should be aware of? Additionally, do you have any medical conditions, such as hypoglycemia or diabetes, that would assist us in tailoring the most suitable program for you? Please provide a comprehensive list of any injuries you have experienced, both current and past, as well as any surgeries you have undergone.

10. Is there any reason not mentioned why you should not follow a regular exercise program?

11. Name of Physician: [Please provide the name of your physician here]

12. Physician Phone: [Please provide the phone number of your physician here]

Progress Photos & Permissions

13. Please upload pictures of yourself here. By submitting your pictures, you acknowledge and agree that Above and Beyond Personal Training may use these images for promotional purposes, including but not limited to the website. We value your privacy and will not share your pictures with third parties without your consent.

14. Your success stories are incredibly valuable to us, not only in showcasing the effectiveness of our services but also in inspiring others to embark on their fitness journey. We understand the importance of privacy and respect your preferences regarding the use of your images. As part of tracking your progress and helping others see the transformative results achievable with our training, we encourage you to provide before and after pictures. These images will be kept strictly confidential and will only be used internally for tracking your progress and improving our services. If you're comfortable, we'd also love to share your progress photos for promotional purposes, such as on our website and social media platforms. Your input matters to us, and we want to ensure that your experience with us aligns with your expectations.

Yes, I’m comfortable sharing my photos for promotional purposesNo, I prefer to keep my photos privateMaybe addYes, but only with my written approval for each use

Your trust and satisfaction are our top priority, and we're here to support you every step of the way.

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Client Intake Form

📸 Please Upload the Following Progress Photos: