Client Contract 7 Step Process Date MM DD YYYY Name * First Name Last Name Email * Phone (###) ### #### Date of Birth MM DD YYYY Height and Weight Occupation Past Medical History (Pregnancy, Surgery etc.) What service(s) are you interested in? Training Nutrition Coaching Both Are you taking any medications or supplements? List below Have you been diagnosed, treated, or have had any disordered eating? Do you experience any of the following symptoms? Headaches Joint Pain GI Issues Difficulty Sleeping Anxiety/depression Cardiac Issues Gaining Weight Losing Weight Fatigue Balance Other When it comes to meals, do you enjoy.. Cooking Eating out Quick at home options How many days a week do you exercise? 1-2 3-4 4 or more Do you enjoy exercise? Yes No If you answered Yes, what types do you enjoy? If you answered No, please explain? Any foods or exercises to avoid? Anything you've tried in the past that didn't work? What are your top goals? (check all that apply) Weight Loss Weight Gain Muscle Gain/More Muscle Definition Body Confidence Nutrition Guidance Conditioning Balance Mobility Other Additional Comments or questions here... Thank you!
