Total Female Fitness

Client Intake & Health History Form

Your customized plan is created largely based on the information you provide in this intake form. Please answer all questions throughly as it really helps me to not only better understand what your needs and goals are, but also to gain greater insight on how I can best support you as your coach.

Name

First Name

Last Name

Date of Birth

You must be at least 18 years old to make this purchase. We do not work with children or teens.

YYYY

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Height & Weight

Please enter your stats in pounds and inches. Convert kilograms to pounds (kg x 2.2) Convert centimeters to inches (divide by 2.54)

Health Goals

What are your current health-related goals? For example: Resolving menopausal symptoms like blank, mitigating headaches, less joint pain, more energy throughout the day, better libido, improve digestion, etc. Please provide at least one short-term and one long-term goal. More is fine.

Fitness Goals

What are your current fitness goals? This can be totally unrelated to weight loss or gaining muscle. For example: Increasing strength, more effective workouts, improved cardiac health, better body image, overcoming mental blocks, etc. Please provide at least one short-term and one long-term goal. More is fine.

Nutrition Goals

What are your current nutrition goals? For example, to increase calories (reverse diet for a better metabolism at maintenance), understand macros, less restriction, regulate hunger cues, stop binge eating on the weekends. Please provide at least one short-term and one long-term goal. More is fine.

Motivation

What is your WHY behind these goals? Why do you want to feel (blank) when you get to (blank result)? This is what will drive you when times get tough.

Daily Lifestyle

What does a day in your life normally look like? How do you spend your time when you are off of work (go to the gym, watch tv, read, walk your dog, etc)?

Weekly Routines

Outside of school/work, are there any weekly commitments that are important to you? For example: church on Sundays, date nights on Saturdays, meeting friends for happy hour on Fridays, etc.

Meals

Do you cook your own meals, or eat out throughout the week? Favorite snacks or treats? What are some typical meals that you prepare, or enjoy?

Water

How much are you hydrating throughout the day? This includes juice, protein shakes, soda, tea and any other drinks you consume in a day, except coffee.

Relationship Status

Are you married or in a committed relationship?

Childern

Are you a parent?

Pets

What pets do you have, if any?

Coaching Experience

Have you ever worked with another personal trainer, nutritionist or health coach before? What was your experience like? Is there anything I should know about your personality or coaching preferences?

Obstacles

When you take into account things you have tried in the past, what are the top 1-2 issues you have struggle with the most.

Activity

How active would you say you normally are, NOT including your workouts?

Sleep

Please rate your sleep.

Sleep Routine

What time do you normally wake up and go to bed? Please note if this is different on your off days from your work days. What is your wake up routine? Doesn't have to be anything formal. For example: Do you hop straight out of bed and hit the gound running, or hit snooze and struggle to get up, etc. What is your night time routie? For example: Do you scroll in bed for several minutes? Read a book? Fall asleep with the TV on? Do skincare for 20min?

Energy

What is your current energy level like throughout the day? For example: Do you crash in the afternoon, wake up not feeling very rested, feel tired but wired at night, have a hard time recovering from workouts, feel strong and peppy all day?

Caffeine

How many servings of caffeine do you normally have a day?

Alcohol

I'm not here to judge, but I'll let you know right now, if you have hormonal or other underlying issues, drinking will make it worse. If you're ready to let it goor at least slow it down -great! This is just to get an idea of how it might be impacting you before we get started.

Stress

Please rate your current stress levels.

Digestion

A lot of people have had poor digestion for so long, they don't realize how bad it actually is. However, it greatly influences hormonal health and your immunity. So it gets it's own category to make sure we don't miss any details that could hinder you. Do you experience constipation or diarrhea regularly? Do you have a bowel movement 1-3 times daily? Do you experience acid reflux? Nausea? Discomfort from bloating? Reactions to certain foods?

Health History

Please understand I do not work with individuals with a diagnosed eating disorder or body dysmorphia. I recommend you seek help from an expert for treatment. Services, content and recommendations are not prescriptions and should not be construed as medical advice, or a replacement for medical advice. If you are currently under treatment for injury, illness or mental health issues, it is your responsibility to get clearance from your doctor prior to purchasing this service. Please specify the following: If you are currently pregnant, or trying to get pregnant. Also, if you are currently breastfeeding. If you have a history of chronic illness, cardiovascular disease, hormonal issues (PCOS, endometriosis, diabetes, adrenal issues, thyroid conditions, menopausal, etc). If you are experiencing any known nutrient deficiencies, allergies, food sensitivities or dietary restrictions for medical reasons. Any medications or over-the-counter remedies (such as pain medicine, anti acids, laxatives or sleep aides, etc) you think I should be aware of? Please let me know if you have any past or present injuries that may hinder you, or other health concerns I should be aware of.

Supplements

Please list any supplements you are currently taking. This includes specific protein powder, pre workout, BCAAs, collagen, creatine, green powder, probiotics, vitamins/minerals, adaptogens/herbs, etc.

Training Experience

Please rate your level of experience with weight training.

Workouts

Please be SPECIFIC about your workout routine. Include your availability to get to the gym. This is very important for me to reference when I create your plan. If you don't currently workout, that is ok. Just say, "I haven't exercised regularly for X amount of time." If you are already lifting weights regularly, what's your weekly split like and how long does it typically take you to train? Do you train in a gym or at home? If training at home, what equipment do you have available? I can help you with suggestions if you’re just getting started. How much cardio do you typically do each week, what type, how long is each session? Again, is this at home or in the gym? Do you go to any classes or play any sports? Yoga or pilates?