New Client Intake Form

Name: True Optimal Performance
Address: US
Price range: $$

Please complete this comprehensive intake form to help us understand your health, fitness, and goals. All information is kept strictly confidential.

1. Personal Information

Basic contact and emergency information

Full Name *

Email *

Phone *

Date of Birth *

Age *

Emergency Contact Name *

Emergency Contact Phone *

2. Physical Stats & Training Background

Current physical condition and training history

Current Weight (lbs) *

Height *

Years of Intense Training *

Current Injuries (if any)

Do you own/use a smart watch that tracks daily calories/activity? *

Yes

Current Training Schedule and Rep Schemes *

What time of day do you normally train? *

Current Cardio Regimen (if any)

3. Nutrition

Current diet and eating habits

Rough Idea of Current Diet/Macros *

How many meals do you prefer to eat daily? *

Who prepares your food? (Check all that apply) *

I prepare my own meals

Meal prep service

Spouse/Partner

Combination

Daily Water Intake *

Daily Caffeine *

Alcohol (drinks/week) *

Food Sensitivities / Allergies / Foods to Avoid

4. Supplements & Medications

Current supplement and medication use

Current Over-the-Counter Supplements

Full History with Advanced Supplements

Current Prescription or OTC Medications

Smoking / Nicotine Use *

None

Former (quit ___ years ago)

Current

5. Medical History

Personal and family health history

6. GI Health Questionnaire

Digestive health assessment

7. Lifestyle & Stress

Daily routine and stress factors

8. Goals & Mindset

Your fitness goals and coaching preferences

What goals would you like to accomplish? (Short-term and long-term) *

Why now? What is driving you to seek coaching at this point in your life? *

Have you worked with a coach before? If yes, what worked and what didn't? *

What accountability style works best for you? *

Tough love — be direct, push me hard

Supportive — encouragement and patience

Balanced — a mix of both depending on the situation

What do you see as your biggest obstacles or challenges? *

9. Progress Photos & Signature

Final submission details

Progress Photos

Please email your current posing/full body pictures to [email protected] after submitting this form.

Photo Guidelines:
• Men: posing trunks or boxers
• Women: bikini or sports bra and shorts
• Include front, side, and back views if possible
• Photos are kept strictly confidential and are essential for tracking your progress

Client Signature (Type your full name) *

Date *

Confirmation

By submitting this form, I confirm that all information provided is accurate and complete to the best of my knowledge. This information will be kept strictly confidential and used solely for the purpose of developing my personalized coaching program.

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