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About You

The basics

First name *

Last name *

Email *

Phone / Instagram handle How you prefer to be reached.

Age

City / State

Height

Current weight (lbs)

Occupation Helps me understand your schedule, stress load, and lifestyle rhythm.

Do you have children?

No Yes — no longer newborn Yes — postpartum / newborn stage Currently pregnant

Goals

What are you here for?

Be specific. "Lose weight" is a starting point — what does success actually look like for you?

Primary goals — select everything that applies

🔥Lose body fatRecomposition, leaning out 💪Build muscleStrength and size gains 🏋️Get strongerLift more, perform better 🌿Postpartum recoveryRebuild core, pelvic floor, energy ⚡More energy & better sleepFeel like myself again 🥗Fix my nutritionStop the cycle, build real habits 📅Build consistencyStop starting over every Monday 🪞Body confidence & mindsetChange my relationship with myself

Describe your goal in your own words What does your ideal outcome look, feel, and function like? The more specific, the better I can serve you.

Do you have a specific timeline or event in mind? Wedding, vacation, milestone birthday — or no deadline at all.

Training

Your history with movement

I need to know where you're starting from — not to judge, to build from there.

How would you describe your training experience?

Complete beginner — never really trained Some experience — on and off for years Intermediate — consistent but need direction Advanced — trained seriously 3+ years

How many days per week can you realistically commit to training?

How long can your sessions realistically be?

Where do you train?

What equipment do you have access to? Be specific — barbells, dumbbells, cables, smith machine, bands, bench, etc.

What types of training do you enjoy — or hate? I want to build a plan you'll actually show up for.

Nutrition

Your relationship with food

No judgment here. I need to understand where you're actually starting from — not where you think you should be.

How would you describe your current eating habits?

Pretty inconsistent — no real structure I try to eat well but it falls apart Mostly consistent, some rough patches Very consistent — I track and plan

Estimated daily calories Best guess is fine.

Estimated daily protein

Do you track macros or calories?

Yes — consistently Sometimes — off and on No — never have No — and don't want to

Any dietary restrictions, allergies, or strong preferences?

Are you currently breastfeeding?

Yes No N/A

Anything else about your nutrition I should know? History with dieting, emotional eating, restriction cycles, anything relevant.

Health & Medical

Your body, your history

This section is confidential and used only to keep you safe and build a program that works with your body — not against it.

Do you have any current injuries or physical limitations? Include anything that affects how you move — past surgeries, chronic pain, joint issues, etc.

Any diagnosed medical conditions relevant to training or nutrition? PCOS, thyroid issues, diabetes, anxiety, ADHD, autoimmune conditions, etc.

Are you currently taking any medications or supplements?

Have you worked with a doctor, PT, or specialist recently for anything relevant?

Yes No

Lifestyle

Your daily reality

A plan that doesn't fit your life isn't a plan — it's homework you'll avoid. Help me build something you can actually live.

How much sleep do you typically get per night?

How would you rate your daily stress level?

Very low — I'm pretty chillOff the charts

How active is your daily life outside of workouts?

Mostly sedentary — desk job, minimal movement Lightly active — walking, errands, kids Moderately active — on my feet most days Very active — physical job or high step count

Do you drink alcohol?

Never Occasionally — 1–2/week Socially — a few times a week Regularly — most nights

Describe your typical weekly schedule When do you wake up? Work hours? Kids' schedules? When could training realistically fit?

Mindset

The inner work

What has stopped you from reaching your goals before? Be real. This is one of the most important questions on this form.

How would you describe your relationship with your body right now?

At war with it — frustrated most of the time Disconnected — I try not to think about it Neutral — it could be better but I'm okay Working on it — making progress but still a journey

On a scale of 1–10, how ready are you to commit and do the work?

Still on the fenceAll in, let's go

What's your real reason for doing this? Not the surface answer — the one underneath it. The why that gets you out of bed.

Working Together

How I can best serve you

How do you prefer to be coached?

Straight talk — tell me exactly what to do Explain the why behind everything Encouragement and positive reinforcement Hold me accountable — don't let me off the hook Flexibility — adjust when life happens Consistency over perfection

Have you worked with a coach before?

No — first time Yes — good experience Yes — didn't work out

Anything else you want me to know before we start? Open space — use it however you want.