Training Intake | Inside Out Fitness

CLIENT INTAKE FORM

First name

Last name

Phone

Birthday

Month

Day

Year

Address

Age

Body Weight

Height (inches)

What is your primary goal(s)?

Why is that goal(s) important to you?

What is your biggest struggle(s)?

What is your experience with resistance training?

Where will you be exercising?

Please list the gym you'll be using, OR all of the equipment you have at home:

How many days per week can you commit to working out?

How long (in minutes) can you commit to working out each session?

What does your daily activity look like outside workouts?

If you currently track your steps, how many do you average each day?

What is your experience with tracking food?

If you track your food, what were your most recent macros set at (calories, protein, carbs, fats, fiber)?

Please explain a current typical full day of eating in detail:

Please list all food allergies, aversions, or preferences:

IF RECEIVING A CUSTOM MEAL PLAN... what style would you prefer?

IF RECEIVING A CUSTOM MEAL PLAN... How many times per day is it realistic for you to eat?

IF RECEIVING A CUSTOM MEAL PLAN... do you make meals for a family as well?

IF RECEIVING A CUSTOM MEAL PLAN...are there any specific foods or meal requests that you'd like us to try and incorporate in the plan?

How many oz of water do you drink per day on average?

How many hours of sleep do you get on average each night?

What is your typical sleep quality?

What is your typical daily energy level?

What best describes your bowel movements?

What best describes your typical daily stress levels?

Have you had a heart attack or stroke?

Do you have high blood pressure?

Do you have diabetes?

Do you smoke?

Do you have joint pain or arthritis?

Please list any chronic illnesses or pain:

Have you had any surgeries in the last 5 years?

[WOMEN] Are you pregnant or breastfeeding?

[WOMEN] Have you had a partial or full hysterectomy?

Do you have any hormone imbalances you're aware of?

Please list all medications you're on:

Please list all supplements (and their brands) you're taking:

Is there anything else you'd like us to know about you as we start?

Please select the trainer you're working with:

YOU have so much to offer the world!

Don’t let it hide behind insecurity, laziness, and past failure.

It’s time to become your best version and share your gifts with the world!