Let us help you identify the small wins for big changes in your life! Complete the CLIENT intake form below to get started!
Plan includes:
- A one time, custom plan based on your schedule to set habits and create “small wins” around your priorities to center around a higher and better focus for fitness, nutrition, and mental health.
- 2 weeks of support from the date that your plan is provided.
- Suggestions for organizing tools, systems, etc. to lead to better habits and rewarding benefits at a smaller scale to help the big picture
- Book and article suggestions for continued focus on the right thought process for successful automaticity to achieve your fitness/nutrition and mental health goals.
Let’s get started by answering the below questions!
CLIENT INTAKE FORM: YOUR PERSONALIZED TRANSFORMATION PLAN - one brick at a time
Welcome! This form will help us create a personalized strategy to help you level up your fitness, nutrition, and overall quality of life — one small, powerful step at a time.
Basic Information
- Full Name:
- Email Address:
- Age:
- Occupation and Daily Schedule (brief description):
Health & Fitness
- How would you describe your current fitness level?
(e.g., inactive, somewhat active, very active) - What are your top 2–3 physical goals right now?
(e.g., build muscle, lose fat, increase energy, get stronger, move better) - How many days per week can you realistically commit to intentional movement or workouts?
- Do you have any injuries, limitations, or health conditions we should know about?
Nutrition & Lifestyle
- Describe your current eating habits in a typical day.
(Be honest — no judgment here.) - What is your biggest challenge when it comes to nutrition?
(e.g., consistency, cravings, lack of knowledge, time, emotional eating) - How many hours of sleep do you usually get per night, and how rested do you feel?
- On a scale of 1–10, how would you rate your current stress levels?
(1 = minimal stress, 10 = extreme stress)
Optional: What are the top sources of your stress?
Mindset & Motivation
- What does a “better life” look like to you, realistically, in the next 6–12 months?
(Think in terms of energy, confidence, routine, relationships, etc.) - What tends to stop you or slow you down when you try to make positive changes?
- What would success feel like for you at the end of this program or plan?
(Describe the habits, mindset, or lifestyle you’d be proud of.)