IN-person/remote PROGRAM FORM

BASIC INFORMATION

First name

Last name

Phone

Age

Height

Current Weight

Goal Weight

How many meals per day do you currently eat?

1 - 2

3 - 4

4 - 5

Do you snack in between meals?

Yes

Any food allergies or sensitivities?

Any dietary preferences (e.g., vegetarian, gluten-free, etc.)?

Do you currently track your food? (e.g., MyFitnessPal, macros, calories)

Are you comfortable with tracking macros, or is it new to you?

Yes

What does a typical day of eating look like for you?

What’s your job and how active are you during the workday? (e.g., desk job, on your feet all day, mix of both)

How active are you outside of work? (e.g., walking, errands, childcare, recreational activity)

What days/times are best for workouts?

How many days per week are you realistically able to commit to training?

Do you have access to a gym or equipment at home? If so, what equipment do you have? (for remote training)

Any current or past injuries I should know about?

Any movement restrictions or chronic conditions?

Are you currently cleared for exercise by a doctor?

Yes

What are your main goals? (e.g., fat loss, muscle gain, increased energy, confidence, accountability, etc.)

What are you hoping to get out of training?

How long have you been working toward these goals?

What has or hasn’t worked for you in the past?

What motivates you?

What usually derails your progress?