6 Month Lifestyle/Bodybuilding Coaching Intake Form

Please answer the questions below with as much detail as possible. This will help me to really know and understand you and your goals so I can create the best plans for you!

INTRODUCTION

First name

Last name

Birthday

Month

Day

Year

Height

Weight (morning weight, after using the restroom & prior to eating or drinking)

What do you do for work & what does a typical day look like for you?

How many steps per day do you average? (If you do not have something like a Fitbit or Apple watch that tracks steps, your smartphone should have a health app that tracks them.)

DIET & NUTRITION

Please be very specific here. My goal is to create a plan that works for YOU! We want it to support your goals while being sustainable & including your tastes & preferences.

Allergies &/or Intolerances:

Favorite Foods (Please include ALL of your faves – even if they are ones you might be trying to decrease intake of or that you do not consider “healthy”. There truly are no “bad” foods & it helps me to have a good understanding of the foods you enjoy.)

Foods you dislike:

Tell me about your current diet. (Please outline a typical day of food for you. Include quantities. Instead of saying eggs & toast, it helps me understand your caloric & macronutrient intake if you tell me 3 eggs & 2 slices of toast & butter.)

TRAINING HISTORY

What physical activities or types of exercise have you done in the past (include any history of sports or exercise classes)?

Please tell me about your most recent activity levels. What has the last month or 2 been like for you in terms of activity level?

If you are currently weightlifting, what is your current training split? How many days per week?

Are you currently doing any form of cardio? If so, what type and approximately how often for how long?

Access to Exercise Equipment – Do you currently attend a gym? Do you have exercise equipment at home? If so, what types of equipment do you have?

If you attend a gym, how many years have you been going to the gym?

What are your favorite activities & exercise modalities?

What time of day do you prefer to train? Please be as clear as possible so I can tailor your diet around training. Do not just say “morning” or “late afternoon”.

What time of day do you typically wake up?

What time of day do you typically go to bed?

HEALTH

Do you have any medical diagnoses, health issues or concerns that you feel would be helpful to share so I can best serve you?

Do you take any prescription medications or health supplements?

YOUR GOALS

What do you hope to achieve in the short term with me?

What is your long term goal?

Once form is submitted, please email current pictures (front, back, side and side).

DISCLAIMER

I, the undersigned, certify and acknowledge: That Evolve Personal Performance and associates (in association with Evolve Personal Performance, LLC), are independent personal trainers and nutrition advisors, and have advised me prior to my commencement of participation in cardiovascular resistance training programs and diet that such participation could result in physical injury.

That I, the undersigned, freely and knowingly assume the risk in such programs, and I hereby waive any right, claim, or cause of action against Evolve Personal Performance and associates and release them and/or associates from any liability for any injury, illness, cost, damage expense or claim, which I or anyone on my behalf might incur as a direct or indirect result of my participation in this cardiovascular, resistance-training program and diet.

That I, the undersigned, fully understand that Evolve Personal Performance and associates have the right to terminate my plan based on declining health, both physical and mental.

That I, the undersigned, fully understand the qualification that Evolve Personal Performance and associates hold, and understand that the advise given is hypothetical and not given from a medical or nutritional professions.

That I, the undersigned, freely and knowingly accept that there is NO REFUND once initial plan is received.

That I, the undersigned, have read this Liability Waiver form, understand and agree with each of the aforementioned points, and have received a copy of this release from on this date. A signature below and payment will be taken as signature and agreement of this liability waiver from and also confirms that the information I have provided to Evolve Personal Performance and associates is correct and true.

Signature

Signature field is empty.

Date Signed

Month

Day

Year

SOCIAL MEDIA POLICY & USAGE

We adopt a Social Media Policy to ensure our business and our staff conduct themselves accordingly online. While we may have official profiles on social media platforms, users are advised to verify authenticity of such profiles before engaging with, or sharing information with such profiles. I, the undersigned, release any pictures to Evolve Personal Performance and associates to use for social media/marketing purposes. We will never ask for user passwords or personal details on social media platforms. Users are advised to conduct themselves appropriately when engaging with us on social media.

There may be instances where our website features social sharing buttons, which help share web content directly from web pages to the respective social media platforms. you use social sharing buttons at your own discretion and accept that doing so may publish content to your social media profile feed or page.

Signature

Signature field is empty.

Date

Month

Day

Year

By making payment for our 6 month Lifestyle or Bodybuilding plan on the next screen, you agree that you have read and accept the terms and conditions as detailed her in our Disclaimer and Social Media Policy.

Your payment method will be securely stored and automatically charged again in 6 months unless you remove or update your card before the renewal date.