New Client Questionnaire - Everyday Motivate

Name

First

Last

What current conditions

Email

Phone Number

Date of Birth

Occupation

What are your top 3 health and fitness goals?

If other please explain.

What is your primary motivation for wanting to make these changes?

If other please explain.

What challenges or obstacles have prevented you from reaching your goals in the past?

How committed are you to making lifestyle changes? (1 = not at all, 10 = fully committed)

Selected Value: 0

Do you have any medical conditions I should be aware of?

(e.g., diabetes, high blood pressure, IBS, food allergies, past injuries, etc.)

Are you currently taking any medications or supplements?

Have you had any recent surgeries or injuries that may affect your training or diet?

Do you have any food allergies, intolerances, or any foods that you avoid?

Do you experience any digestive issues?

(e.g., bloating, constipation, acid reflux, irregular bowel movements)

Do you have any family history of medical conditions?

(e.g. heart disease, diabetes, or autoimmune disorders)

On a scale of 1-10, how would you rate your current nutrition?

Selected Value: 0

1 = poor, 10 = excellent

Do you follow a specific diet?

(e.g., vegetarian, keto, intermittent fasting, etc.)

Do you cook at home, or do you mostly eat out?

How often do you eat processed foods, fast food, or sugary snacks?

Think daily, weekly or rarely.

How much water do you drink daily?

Do you consume alcohol? If so, how often?

Do you drink coffee or energy drinks? If so, how much per day?

How many hours of sleep do you get per night?

On a scale of 1-10, how would you rate your stress levels?

Selected Value: 0

1 = relaxed, 10 = stressed out

What are your main sources of stress?

Do you have any gut-related symptoms?

(e.g., bloating, gas, diarrhea, constipation)

Do you currently exercise? If so, how often and what type of workouts do you do?

How would you describe your current fitness level?

Beginner
Intermediate
Advanced

Do you have experience with strength training or calisthenics?

What type of physical activities do you enjoy?

(e.g., weightlifting, yoga, hiking, running, swimming, sports)

Do you have any physical limitations or pain that may affect your ability to exercise?

Do you have access to a gym or prefer home workouts?

What habits are you currently trying to improve?

(e.g., stress management, meal prepping, consistency)

Do you have support from family or friends for your health goals?

Are there any lifestyle factors that may impact your nutrition or training?

(e.g., work schedule, travel, children)

What motivates you the most to stay consistent?

Is there anything else you’d like me to know before we get started?