The intake form for a new client

1. Your goals

1. What you want to achieve (tick all that apply)

   • Lose fat
   • Build muscle
   • Get fitter and healthier
   • Improve at a sport
   • Prepare for an event
   • Get back after an injury or a break

2. Why now? What would change for you?

3. Any date or event coming up?

   A race, a wedding, a season: give the date.

4. In three months, how will you know it worked?

2. Your training

1. Your level today

   • I don’t exercise
   • I’m getting back into it, or have trained for less than six months
   • I’ve trained regularly for six months to two years
   • I’ve trained for more than two years

2. What you do now, and how many times a week

3. What you enjoy, and what you never want to do again

3. Your availability

1. Sessions possible per week

   • 1
   • 2
   • 3
   • 4
   • 5 or more

2. Session length

   • 30 minutes
   • 45 minutes
   • 1 hour
   • 1 hour 30

3. Where you can train (tick all that apply)

   • At a gym
   • At home
   • Outdoors
   • By video call

4. The equipment you have

4. Your daily life

1. Your job and your working hours

2. Your sleep

   1 = very poor · 5 = excellent

   • 1
   • 2
   • 3
   • 4
   • 5

3. Your stress level

   1 = very calm · 5 = very stressed

   • 1
   • 2
   • 3
   • 4
   • 5

4. What you eat on a typical day

5. Your health

1. Has a doctor ever told you to exercise only under medical supervision?

   • Yes
   • No

2. Do you feel pain in your chest when you exert yourself?

   • Yes
   • No

3. Have you ever fainted or felt faint during or after exercise?

   • Yes
   • No

4. Do you take any regular medication?

   If yes, what for: your coach does not need the medical detail.

   • Yes
   • No

5. Do you have an injury or pain right now?

   If yes, where, and since when.

   • Yes
   • No

6. Are you pregnant, or did you give birth less than a year ago?

   • Yes
   • No

7. Past surgery, injuries or health problems your coach should know about

A “yes” to any of these questions: ask a doctor’s advice before you start. This form does not replace medical advice.

6. Your consent

1. I agree that my coach keeps these answers, including those about my health, to adapt my training. I can withdraw this consent at any time.

   • I agree