Intake Assessment | Divine Fitness

This intake form will help us to create your personalized program

Personal Information

Full Name *

Phone *

Email *

By entering your phone number and email, you are agreeing to receive SMS/Email messages from Divine Fitness. You can reply with STOP at any time to stop receiving SMS messages.

Assessment Details

Gender

Date of birth

Age

Weight (Pounds) *

Height (Inches) *

What compelled you to reach out to us?

Primary Goals

What are your main goals?

What types of things have you tried to solve this problem in the past? Be as DETAILED as possible -- worked with a trainer? Diets? Bootcamps? DVDs? Supplement programs? etc. Again, we want to know everything you've tried so we can make sure you never have to add to that list again :)

What's the biggest obstacle keeping your from reaching that goal right now?

Why this program instead of all the other things you could do?

What makes solving this now a MUST? Why not wait another week, month, year, etc.? What will change in your life by fixing this now?

Health issues or physical limitations that might limit your ability to follow the plan *

Please give us a detailed explanation of your current eating habits and what you think you do well and what you think you struggle with the most

What are your non-negotiables? (think of aspects of your life that you prefer not to give up - social events, date nights, family dinners out, etc)

How many alcoholic beverages do you consume on average per week?

Please describe your current training routine? (include all modalities that you partake in) *

Apply *

I have a food scale

I have weighed out my food portions before

I am currently weighing out my food portions more than 70% of the time

I am willing to weigh out my food portions

I have tracked my food in an app such as MyFitnessPal, Cronometer, etc

I am willing to track my food

What do you do for work? Would you describe it as a relatively sedentary job or a high activity job?

How would you describe your quality and quantity of sleep on average?

Do you currently meal prep or plan any of your meals for the week? Do you enjoy cooking, meal prepping/ planning?

How would you describe your hunger levels throughout the day?

How has your digestion been over the last month? (Daily BM's, bloating?)

Do you have any health concerns or hormonal concerns that you would like your coach to know about?

How active are you?

Does your spouse or significant other support you? (i.e. will they give you a thumbs up on whatever you decide?)

What do we need to know about you in order to coach you the best?

Where in town are you located?

Where would you like to train?

Home

Gym

Apartment/HOA Gym

Park

What equipment do you have access to?

How often are you looking to train? And do you have preferred times/days?

Location?