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Client Intake Form

Intake assessment for new private coaching clients.

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About You

Your personal details.

Question 2 of 57

Full name

Question 3 of 57

Preferred name or nickname

Question 4 of 57

Age

Question 5 of 57

Location & time zone

Question 6 of 57

Occupation & typical work hours

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Who do you live with, if anyone?

Question 8 of 57

Any dependents or caregiving responsibilities?

Your Daily Rhythm

Questions about your daily flow and sleep schedule.

Question 10 of 57

What time do you typically wake up and go to bed?

Question 11 of 57

How would you rate your sleep quality?

A

Excellent

B

Good

C

Okay

D

Poor

Question 12 of 57

Please tell me more about your sleep. For example, Do you have a hard time falling asleep but sleep well after that? Do you wake up a lot throughout the night? Do you wake up too early? Do you wake up feeling rested or the opposite?

Question 13 of 57

Do you get natural sunlight in your eyes in the morning?

Question 14 of 57

How much time do you spend outdoors each day?

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 Do you experience energy dips or crashes during the day? If so, when?

Movement & Fitness

Tell me about your activity level, movement, and fitness.

Question 17 of 57

Do you currently exercise? If so:

 

-What kind?

-How often?

-How do you feel afterward?

 

Question 18 of 57

Do you ever experience pain during or after movement? Where?

Question 19 of 57

Have you followed a structured strength or cardio training program before?

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What does your daily physical activity look like outside of workouts?

Question 21 of 57

How would you describe your mobility or flexibility right now?

Nutrition & Nourishment

Tell me about your relationship with food.

Question 23 of 57

Describe a typical day of eating — what, when, and how much.

Question 24 of 57

Any food sensitivities or allergies I should know about?

Question 25 of 57

Do you currently follow a specific dietary style or philosophy (e.g. paleo, vegetarian, intermittent fasting)?

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How often do you cook at home?

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Do you eat alone or with others most of the time?

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What’s your relationship with food like emotionally? (Is it a source of stress, pleasure, control, comfort?)

Pain, Discomfort & Healing

Let’s listen to what your body has been trying to tell you.

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Are you experiencing any chronic or recurring pain? If so, where and for how long?

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Have you had any injuries or surgeries?

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Do you ever experience digestive issues, headaches, or skin problems?

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What have you tried in the past to address these concerns?

Stress & Nervous System Health

You deserve to feel at home in your body — not in constant fight-or-flight.

Question 35 of 57

On a scale of 1 to 10, how would you rate your overall stress level right now?

Question 36 of 57

What are the main sources of stress in your life?

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How does stress show up in your body (tightness, poor sleep, irritability, etc.)?

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Do you currently practice meditation, breathwork, prayer, or any other form of nervous system regulation?

Question 39 of 57

When was the last time you felt truly at peace?

Relationship with Nature

Nature is not a vacation attraction - we are quite literally OF it.

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How much time do you spend in nature each week (parks, forest, ocean, etc.)?

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Is there a natural environment you feel particularly drawn to or connected with?

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Do you feel disconnected from nature in any way?

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What’s your relationship with technology and screen time like?

Goals, Vision & Readiness

This is about more than outcomes — it’s about how you want to feel.

Question 46 of 57

What do you most want to change or improve in your life right now?

Question 47 of 57

How would you describe your ideal state of health and well-being?

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What does “strong” mean to you?

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What’s been standing in your way?

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Why now?

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On a scale of 1 to 10, how ready are you to commit to this process?

Training Equipment and Inspiration

There are no wrong answers here - just want to get clarity on these items.

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Are you going to be training in a gym or at home?

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What training equipment do you have?

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What is your budget for investing in equipment?

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What style of training do you feel most curious about and/or inspired to practice?

Question 57 of 57

If there's something I didn’t ask that feels important to share, I’d love to hear it here...

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