#Perfectfit4u | Nutrition, Fitness, Wellness
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#Perfectfit4u | Nutrition, Fitness, Wellness
  • HOME
  • PROGRAMS & SERVICES
    • Virtual Coaching
    • In-Person Coaching
      • 12-Week Programs
      • Fitness Assessment
      • Personal Training
    • Specialty Programs
      • Competition Prep
      • Transformation Challenge
      • FemSport Training
    • Workshops & Events
      • Health & Wellness Retreat
      • Food School
    • More
      • Body Composition Testing
      • #PF4U App
      • #PF4U Cookbook
      • #PF4U Fitness On-The-Go
      • #PF4U Guidebook
      • Gift Certfificate
  • SUCCESS STORIES
  • ABOUT
    • BLOG
  • BOOK APPOINTMENT
  • Notifications

Client Intake Form

Homepage Client Intake Form

Client Information


Occupation

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Contact Information


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Health Information


0 / 180
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0 / 60
Please list condition(s) and medications0 / 180
How many times per day?0 / 180
How many drinks per week (on average)?0 / 180
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(1=worst, 5=best)
(1=worst, 5=best)

Training Information


(1=worst, 10=best)
Number of times/week and how long/session.0 / 180
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A.) Number of times per week? B.) Time (minutes) per session?0 / 180
If you answered YES to the previous question, what GYM do you have a MEMBERSHIP too?
a. How many days at home? b. How many days at the gym?
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Nutrition Information

(1=Poor, 5=Excellent)
(Ex. Celiac, Lactose Intolerance, etc.)
0 / 180
0 / 180
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If so, please explain (Ex. Paleo, Vegan, Vegetarian, etc.) Feel free to explain further if needed. 0 / 180
(i.e. food diary)
(1=Poor, 5=Excellent)
(1=not very, 5=every meal)
(i.e. Stove, Oven, Toaster, Blender, Microwave, etc.)0 / 180
0 / 180

Miscellaneous


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(for iPhone or Android) for $3.99/month?
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Start Photos

Do you have your start photos ready for upload? If so, upload them below. If not, please email front, back and side profile photos to info@perfectfit4u.ca

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PARQ

Physical Activity Readiness Questionnaire


Please select today's date.
#Perfectfit4u creates custom nutrition programs suited to your aesthetic and athletic goals.

CONTACT US

255 – 12 Street North
Lethbridge, AB.
T1H 2G3

info@perfectfit4u.ca

1-587-425-FOOD
1-587-425-3663

Mon-Thurs: 9am-430pm
Fri: 9am-1pm

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