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New Client Intake Form
Thank you for choosing to invest in your health and wellness. This form helps me understand you better so we can create a plan that’s truly tailored to you. Take your time — there are no right or wrong answers.
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Full name
Your answer
Phone number
Your answer
Email address
Your answer
How did you hear about me?
Instagram/ Social Media
Friend/ family referral
Google search
Other:
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What brings you to coaching right now? What made you decide to reach out?
Your answer
What are your top 1–3 health goals for our time together?
Your answer
What does “feeling your best” look and feel like to you?
Your answer
Which areas of wellness are you most focused on?
Nutrition & eating habits
Movement & exercise
Sleep & recovery
Energy & stress management
Body image & self-confidence
Building sustainable habits
Other
How would you describe your current eating habits?
Your answer
How often do you currently move your body?
Rarely/ not currently
1-2 times a week
3-4 times a week
5+ times a week
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How would you rate your current energy levels on a typical day?
Very low
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10
Very high
Clear selection
How would you rate your current stress levels?
Very low
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Very high
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How many hours of sleep do you typically get per night?
Less than 5 hours
5-6 hours
7-8 hours
8+ hours
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Is there anything about your health history you’d like me to know? (injuries, medical conditions, dietary restrictions, etc.)
Your answer
Have you worked with a health coach, nutritionist, or personal trainer before?
Yes
No
If No, ignore the next question
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If yes, what worked well and what didn’t?
Your answer
What has been your biggest obstacle to reaching your health goals in the past?
Your answer
On a scale of 1–10, how ready do you feel to make changes right now?
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10
Clear selection
What does success look like to you at the end of our coaching journey?
Your answer
What is your preferred way to communicate between sessions
Email
Text/ whatsapp
Voice notes
I prefer to keep communication to sessions only
Clear selection
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