New Client Intake Form If you're new here, you may want to subscribe to my RSS feed. Thanks for visiting!Thank you for selecting The Fabulous Fit Squad to help you achieve your weight loss and overall health goals. Step 1 is to complete the form. All fields are required. Name * Phone * Email Address * Birthday * Height Weight What areas do you want to address with coaching * Improve well being (health and happiness) Improve energy Increase physical activity Mantain or manage current weight Improve eating habits Improve sleep Manage stress What's the one thing do you want more of in your life right now? * What's the one thing do you want less of in your life right now? * Listed below are some typical results experienced by coaching clients. Which 3 are most important to you? (direction, focus, accountability, a new perspective, fitness and nutrition strategies, motivation, new challenges, other-please list) * How much time do you have to workout? How many days/week can you workout? Where do you workout? Gym Home Other If you workout at home, please list what equipment you have On average, how much sleep do you each night? less than 6 hours 6-7 hours 8+hours I have trouble sleeping -- either getting to sleep or staying a sleep Are you stressed? 1 2 3 4 5 1= stress what's that I'm as cool as a cucumber 5= I'm stressed I can't even describe it. Do you have any medical condidtions that would require a doctor's permission to workout? Yes No Do you have any medical conditions, that may make it hard for you to lose weight? Are you pregnant or trying to get pregnant? Yes No Are you nursing? Yes No How many meals/day are you eating? 3 3-4 5-6 How much alcohol are you consuming on average? <1/week 1-2/week 2-3/week more than 4/week I have a tendency to binge drink on weekends 5+ drinks at a time There are no judgements, this information will help me better provide you with a plan. If you are currently using supplements, please let list them. What goals would you like to acheive in the next 30 days? On a scale of 1-5 how commite are you to achieving your goals. * 1 2 3 4 Is there anything else I need to know. Step 2 — services you will receive: 4 — 30 min private phone sessions 2 workout programs Nutrition plan Total cost $260 — click on button below to purchase services.