New Client Intake Form

First Name

Last Name

Phone Number

Date Of Birth

Gender

Male

Female

What are your primary fitness goals?

Weightloss

Muscle Gain

Improved Endurance

Increased Strength

Overall Health Improvement

Stress Reduction

Sports Performance

Do you have any existing medical conditions, injuries, or medications we should be aware of?

How would you describe your current physical activity level?

Do you have any dietary restrictions, allergies, or preferences?

How did you find me?

What have you tried before, and why did'nt it work?

Can you realistically commit to sessions each week?

On a scale of 1-10, how ready are you to make changes right now?

1 Just exploring

10 Fully committed

What does success look like to you in 3 months?

Are you open to changing you nutrition?

How do you typically respond when progress is slow?

How would you describe your current eating habits?

How often do you drink alcohol?

How do you generally handle appointments and commitments?

Have you worked with a coach before?

If yes, what happened?

How do you prefer to communicate between sessions?

Check-ins Everfit App

I prefer minimal contact between sessions

Whats your relationship with accountability?

Email:

Infouniquephysiquehealth@gmail.com

Operating Hours:

Monday - Friday

By Appointment Only