Intake Form

BEFORE YOU BEGIN
Set aside 20 minutes to fill this intake form thoughtfully — it’ll help me coach you with precision and purpose.

First Name

Last Name

Phone

PERSONAL TRAINING & HEALTH COACHING – LIABILITY WAIVER, ASSUMPTION OF RISK, AND RELEASE AGREEMENT
1. Scope of Services
I, Coach Donovan, operate as a certified personal trainer and health coach. I am not a licensed medical professional and do not provide medical diagnosis, treatment, prescription, or therapy. All coaching, training, nutritional, and lifestyle advice is intended for general wellness and fitness purposes only. You should consult your physician or other qualified health provider before starting any exercise, diet, or supplementation program.

2. Collection and Use of Information
This form collects personal and health-related information solely to develop personalized coaching and training programs. All information will be kept confidential and stored securely, and will not be shared without your written consent, except as required by law.

3. Voluntary Participation & Assumption of Risk
You understand that participation in exercise, nutrition changes, and wellness activities carries inherent risks, including but not limited to physical injury, muscle strain, heart attack, illness, allergic reaction, or death. You voluntarily assume all such risks, whether known or unknown, and accept full responsibility for your participation.

4. Accuracy of Information
You agree to provide true, complete, and accurate information to the best of your knowledge. You understand that any failure to disclose relevant medical conditions, injuries, medications, or other information may increase your risk of harm and limit my ability to provide safe, effective guidance.

5. Release of Liability & Waiver of Claims
To the fullest extent permitted by law, you hereby release, waive, discharge, and covenant not to sue Coach Donovan, his business, employees, contractors, or representatives, from any and all liability, claims, demands, actions, or causes of action arising from or related to:

Any injury, illness, condition, or death sustained as a result of participating in any program, whether occurring on-site, online, or remotely;
Any alleged negligence, errors, or omissions in the provision of coaching services;
Any decision you make to act or not act on provided recommendations.

This release applies to you and your heirs, executors, administrators, assigns, and personal representatives.

6. Indemnification
You agree to indemnify, defend, and hold harmless Coach Donovan, his business, employees, contractors, and representatives from any and all claims, damages, liabilities, costs, and expenses (including attorney’s fees) arising from your participation, your breach of this agreement, or your failure to provide accurate information.

7. Severability
If any provision of this agreement is found invalid or unenforceable, the remaining provisions shall continue in full force and effect.

8. Governing Law & Jurisdiction
This agreement shall be governed by and construed in accordance with the laws of the State of Texas, United States of America, without regard to conflict of law principles. Any legal action arising out of this agreement shall be filed exclusively in a court of competent jurisdiction located in Texas, and you consent to the personal jurisdiction of such courts.

ACKNOWLEDGMENT & AGREEMENT
By digitally signing and dating this form below, you affirm that you have read, understood, and agree to all terms and conditions contained in this Liability Waiver, Assumption of Risk, and Release Agreement. You acknowledge that you are of legal age or have the consent of a parent or legal guardian if under 18 years old.

Signature Confirmation: My digital signature below confirms I have carefully reviewed this entire document and voluntarily agree to be bound by its terms.

Digital Signature

Today's Date

BIO SNAPSHOT
A quick glance at your baseline—no judgment, just the essentials.

Age

Sex

Male Female

Weight (lb)

Height (ft)

Body Fat (%)

GOALS, MINDSET, & SUPPORT
Let’s map out your goals—and what it’ll take to get you there. This gives me insight into your motivations, mindset, and support systems.

What is your most important fitness, health, or lifestyle goal right now?

What’s your second biggest goal or priority?

What do you want your life to look like in 1–3 years if you achieve these goals?

How do you feel a personal trainer & health coach can help you best?

What have you tried before?

What has stopped you before?

How confident are you in your ability to transform your health?

Who supports you now — friends, family, coworkers?

What will drive you to keep going when it gets uncomfortable?

NUTRITION & EATING HABITS
Let’s talk food. This helps me understand what you eat, when, how often, and why—so we can build a plan that fits your real life, not someone else’s diet.

Describe what and when you typically eat in a day

Which best describes your overall eating style?

High‑Protein (25–35% protein, moderate carbs/fat) Note: most people overestimate how much protein they actually eat. “Balanced” (10–35% protein, 45–65% carbs, 20–35% fat) Low-Carb / High-Fat (25–40% protein, ~10–25% carbs, 40–55% fat) Keto-Style (15–20% protein, 5–10% carbs, 70–80% fat) Other Not Sure

How much protein do you typically consume per meal?

None / Very Little (e.g., no meat, eggs, beans, or tofu) Small Serving (cheese slice, yogurt, handful of nuts) Moderate Serving (chicken breast, fish fillet, 2 eggs) Large Serving (steak, protein shake, 3+ eggs) Very Large Serving (multiple protein shakes, double meat, 4+ eggs)

What are your favorite foods or cuisines?

Are there any foods you avoid or dislike?

How often and how much water do you typically drink per day?

How often and how much coffee do you typically drink?

How often and how much tea do you typically drink?

How often and how much do you typically drink fruit and/or vegetable juice?

How often and how much do you typically drink dairy?

How often and how much non-dairy milk do you drink?

How often and how much do you typically drink soda?

How often and how much do you typically drink "diet" soda?

How often and how much alcohol do you drink?

Do you experience any symptoms or behaviors if you miss meals?

What makes healthy eating hard for you right now?

Have you ever tracked your food intake?

Yes No

If yes, what did you learn about your habits or needs?

ENERGY, STRESS, & MOOD
Your energy levels, stress, and emotional well‑being are key to sustainable progress. Please share honestly—there are no right or wrong answers.

How would you describe your energy throughout the day?

What are your main sources of stress?

How do you typically react to stress?

SLEEP HABITS & QUALITY
Sleep affects everything—your energy, cravings, recovery, and mood. Let’s get a sense of your sleep patterns so we can work with (or improve) them.

How many hours do you typically sleep each night?

What time do you usually go to bed?

What time do you usually wake up?

If you wake up during the night, how many times do you usually wake—and how long are you typically awake?

Do you use any of the following within 2 hours of bedtime?

Screens Alcohol Caffeine None

Is your sleep environment comfortable? (Cool, dark, quiet, good mattress/pillows?)

Yes No

EXERCISE & MOVEMENT
Let’s talk movement—what you’re doing now, what you’ve done before, and what you actually enjoy. This helps me design a program that works with your body, not against it.

How often do you intentionally exercise?

Never Occasionally (1–2×/week) Regularly (3–4×/week) Frequently (5+×/week)

If you intentionally exercise, what types of activity do you do?

What types of exercise do you enjoy most?

Are there any exercises or movements you dislike or would prefer to avoid?

Do you have any past or current injuries, chronic pain, or movement limitations that affect your ability to exercise?

Have you worked with a trainer before?

Yes No

If yes, what was your experience like? What did you like or dislike—and why did you stop?

WORK & LIFE BALANCE
Your schedule, job, and home life all play a role in how easy (or hard) it is to build new habits. Let’s get a clear picture of what your days look like so we can make health fit into your real life.

What’s your job title or current role?

What type of work schedule do you follow?

On average, how many hours do you work each day?

How much do you enjoy your work?

What’s your current home and family situation?

What aspects of your work or home life might make healthy habits harder to maintain?

How much daily time do you have for yourself—non-work, non-family time?

Less than 30 minutes 30–60 minutes 1–2 hours More than 2 hours

Medical & Health History
To build a plan that’s both safe and effective, I need a clear picture of your health history. These questions are optional—but they’re the important ones in helping me coach you responsibly. You can skip anything you're uncomfortable sharing and request permanent deletion of your information at any time.

Do you have any current or past medical conditions?

List any medications or supplements you take regularly, and what they’re for.

Have you had any major injuries, surgeries, or hospitalizations?

Do you have any allergies or sensitivities?

Do you smoke or vape now, or have you in the past?

Has alcohol ever caused health issues or required support (e.g., diagnosis, treatment, dependence)?

Do you currently use recreational drugs?

How often do you have bowel movements, and do you experience any issues?

Do any major health conditions run in your family?

For women: Are you currently pregnant, planning to be, or postpartum?

For women: Are you perimenopausal, menopausal, or experiencing hormonal symptoms?

For women: Any known hormonal conditions like PCOS or thyroid disorders?

Coach Donovan's Intake Form

You Lay It Out — I’ll Build Your Health & Fitness Plan.

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