Client Intake Form

Tell us about yourself

Client Information

Personal Information

Current Health Information - Par-Q Form
If you answer "Yes" to any of the following questions, we will require a doctor's note prior to beginning your training program.

Lifestyle Related

Developing Your Fitness Program

Please send PHOTOS ( and a LIST of the equipment that you have at your disposal.

Goal Setting

Nutrition Information
Please answer YES or NO to the following questions, unless otherwise stated:

Chicken Breast, Lean Ground ChickenTurkey Breast, Lean GroundTurkeyEggs, Egg WhitesTilapiaCodShrimpCanned TunaHaddockHalibutSalmonBeef (Steak or Ground)YogurtCottage CheeseProtein PowdersProtein BarsOatsCream of WheatCereals, GranolasRice Cakes, MelbaToasts, CornThins, Rice CrackersRiceQuinoaCouscousMilletSweet PotatoesWhite PotatoesPasta/NoodlesBread & WrapsBeans (Black, Pinto, Kidney)Berries (Strawberries, Blueberries, Blackberries, Raspberries, etc)Tropical Fruits (Banana, Mango, Pineapple, Grapes, Kiwi etc.)Melons (Cantaloupe, Honeydew, etc.)Seeds (Chia, Flax, etc.)Nuts (Almonds, Pecans, Cashews, Brazil Nuts, etc.)Nut Butters (Peanut, Almond, Cashew)Avocado/GuacamoleCream CheeseOlive OilCoconut OilI am open to anything


Please Explain The Type Of Coach You Want