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Onboarding Intake Form
First Name
Last Name
Email
Phone
Date of Birth
Age
Gender
Choose an option
Where Do You Live?
Biometrics
How Tall Are You?
How much do you weigh?
What is your current Body Fat Percentage (if known)?
Goals
What are your current fitness goals?
What are your nutritional/dietary goals by the end of this program?
What has worked for you in the past?
What has NOT worked for you in the past?
Lifestyle
Do you consume alcohol?
*
Yes
No
If you consume alcohol, how often, what kind(s), and how much?
Are you willing to reduce your alcohol intake for the duration of this program?
Yes
No
Do you consume recreational drugs?
*
Yes
No
If you consume recreational drugs, what kind, how often, and how much?
How many steps per day do you take on average?
Nutrition
Do you have any dietary restrictions?
*
Yes
No
If you have any dietary restrictions, please list them here:
List out the foods that you do not like and really do not want in your nutrition program:
List out the foods that you love:
Exercise
Briefly describe your current exercise routine/program:
Do you have access to a commercial gym?
Yes
No
List any commercial gyms you have access to:
Do you have at-home workout equipment?
Yes
No
List any at-home work out equipment you have access to (be thorough):
Rate your confidence in exercise and working out in general:
Choose an option
Medical
Do you have any relevant medical conditions or restrictions?
Yes
No
List any relevant medical conditions or restrictions here:
List any significant injuries or surgeries you’ve had:
If you are taking any prescription medications, list them here, include dosage and frequency:
Any other information your coach should be aware of?
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