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Weight Loss Client Intake Form Template

Are you looking for a way to help your weight loss clients get off to the right start? With the Weight Loss Client Intake Form Template, you can easily capture all the pertinent information to get your clients on their way to success.

This form template is easy to use and allows you to quickly collect the information you need to get your client's weight loss journey underway. It captures all the critical details of their health history, lifestyle and current nutrition and fitness habits. This information can be used to help you create a customized plan for each individual client.

The form also includes a section for you to provide your client with any resources or materials that will help them reach their goals. This helps ensure that your clients are equipped with the tools and knowledge needed to reach their weight loss objectives.

This Weight Loss Client Intake Form Template is designed to help you save time and streamline your client intake process. With this template, you can quickly capture all the key information you need to start each client on the right foot and achieve their weight loss goals.

Weight Loss Client Intake Form Template

  1. Phone Number
  2. Preferred Contact Method
  3. Address
  4. Birthday - DD.MM.YYYY
  5. What time zone are you located in?
  6. Would you like our zoom calls recorded for your reference?
  7. Do you have any pre-existing illnesses, injuries or limitations that may be affected by exercise, weight loss or general coaching?
  8. If you answered yes, please list your pre-existing illnesses, injuries or limitations:
  9. Do you have any of the following pre-existing medication conditions? Please check all that apply.
  10. Please list any pre-existing illnesses you currently have that are not listed above.
  11. Do you have any dietary preferences or restrictions?  Please list here.
  12. If you've tried other diets or weight loss methods before, please list them here.
  13. What is your current weight?
  14. What is your desired weight?
  15. Why is this result important to you?
  16. What will it cost you if you don't commit or follow through?
  17. What must you believe in order to achieve your desired result?
  18. What thoughts will you have to stop thinking or believing to achieve your desire result?

  19. How do you want to celebrate your ultimate desired result/goal?
  20. Please read the agreement found here and click the box below to agree to the terms.
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