Client Intake Form | Fitway Veteran

Full name

Phone

Age

Gender

Weight

Height (cm)

Who referred you

Occupation

Target weight

Target timeline

Goal

Sleep time

Time

HoursMinutes

Work Type

Diet Type

Wake up time

Time

HoursMinutes

Activity level

Sleep quality

Stress level

Daily water intake

How many days per week do you exercise?

Type of exercise

Foods you dislike

Foods you like

Food allergies

Type your work timings and your meal timings — at what times you can realistically eat meals

Working hours (Start – End)

Meals per day

What do you usually eat in a day?

How committed are you to following the plan?

Current medications

Have you had surgery in the past?

Recent blood test results (if available)

Any medical issues?

NO

Yes

If yes

Any special requests or notes for the coach? (if any)

“I confirm that all information provided is true and accurate. I understand that diet and fitness plans are based on the information I provide. I accept responsibility for informing the coach about any medical conditions, allergies, or health changes. I agree that the coach is not responsible for health complications arising from undisclosed medical issues.”

FITWAY VETERAN CLIENT INTAKE FORM

Coach Ankush | Personalized diet and transformation plan

FITWAY VETERAN