Personal Coaching Intake

Client information

The basics I need to understand your day-to-day life.

First nameLast name

AgeHeightCurrent weight

Goal weightPhone number

Email addressOccupation

Typical work schedule

Do you travel frequently?

YesNo

Goals + motivation

What you want—and why it deserves your effort.

Primary goal

Another goal not listed aboveWhy is achieving this goal important to you?What would success look like six months from now?

Nutrition habits

No judgment—just a clear view of your current routine.

How many meals do you typically eat each day?

Typical breakfastTypical lunch

Typical dinnerTypical snacks

How often do you eat fast food each week?

Never1–2 times3–5 timesDaily

Do you currently track calories or macros?

YesNo

If yes, what app do you use?Food allergies or dietary restrictions

Foods you loveFoods you dislike

Training + health

Your experience, preferences, and anything we need to train around.

Current exercise days per weekWhat gym do you belong to?

Training preference

MachinesFree weights

How long have you been lifting?What does your current workout routine look like?

Do you do any cardio?

YesNo

If yes, what type and how often?Average daily step countInjuries or physical limitationsMedical conditions your coach should know aboutMedications that could affect weight or exercise

Lifestyle + accountability

The support structure that will make the plan easier to follow.

Average sleep per nightHoursDaily stress level0 = low, 10 = very highCommitment level1 = unsure, 10 = all in

What usually causes you to fall off track?What has prevented you from reaching your goals in the past?

What type of accountability helps you most? Choose up to three.

Preferred communication

Facebook MessengerTextEmail

Progress + agreement

Optional starting photos, measurements, and your coaching commitment.

Front progress photoOptional · image filesSide progress photoOptional · image filesBack progress photoOptional · image files

Current body weightMorning, after bathroomDate

Optional body measurements

I understand results come from consistency, not perfection.I agree to communicate honestly during weekly check-ins.I understand that coaching provides guidance, accountability, and education, and my results depend on my adherence to the plan.

Your answers—including health information and optional photos—are submitted directly to the existing secure Jotform intake system and used only to evaluate and support your coaching.

Final stepReview your answers, then send your intake.