Intake Questionnaire

"*" indicates required fields

Step 1 of 16

First Name*

Last Name*

Phone*

Email*

Address*

Address Line 2

City/Town*

State/Region/Province*

Zip/Post Code*

Country*

Date of Birth*

MM slash DD slash YYYY

Biological Sex*

Space given for notes as needed

Occupation*

What do you do for a living, or for most of your days?

How did you hear about us?*

We love to say "Thank You!" for referrals!

Height*

Current Weight*

What does an average day for you consist of?*

Walk us through a typical day in your life

How would you describe your current approach to eating?*

Looking back at the last couple months, how would you describe how you have been eating and or/drinking? Any sort of tracking or emphasis or just sort of eating by feel? No judgement, be honest!

Dieting History*

Please tell us what you've tried in the past as far as different approaches to your nutrition

Exercise*

What does a week's worth of exercise or training currently look like for you?
Some come to us sedentary and that's okay, we want to know what your body is accustomed to at present.

Family Life*

How would you describe your family life and/or support system?

Goals*

What are your goals? Mental, physical, body related, mindset related, however big or small, let's hear them!

"That One Thing"*

What is a physical goal that right now may seem sliiiiiightly out of reach, but that you would LOVE to make happen?

Advice for Us*

Anything you'd like to share that the previous questions may have not captured. Don't worry, you will have ample opportunity to talk Live with your Coach during your onboarding call as well but this space is for you to share away with anything about you, your life, your routine, or your history, that you feel will best enable us to support you through this journey together!

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Intake Questionnaire

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