KGP — Client Intake Form

01 Identity & Contact

First Name *

Last Name *

Date of Birth *

Email Address *

Phone / WhatsApp *

Sex *

Male Female

Gender Identity Optional — helps us communicate with you respectfully.

02 Habits & Lifestyle

Occupation *

Household size *

Do the people around you support your health goals? *

Yes No Other

Tell us more

How willing are you to do whatever it takes to make a positive change? *

5

1 — Not at all10 — Absolutely committed

How much water do you drink daily? *

How do you typically deal with stress and anxiety? *

Approximate daily step count *

Daily stress level *

5

1 — Very low10 — Extremely high

Do you consume alcohol? *

Yes No Other

How many drinks per week?

What do you typically drink?

Do you use tobacco or nicotine products? *

Yes No Other

How frequently?

What products do you use?

Do you use recreational drugs? *

Yes No Other

How frequently?

Which substances?

03 Biometrics

Height *

Current Weight *

Goal / Stage Weight

Estimated Body Fat %

Body Fat Measurement Method

04 Goals & Coaching History

What is your primary goal? *

Do you have a target date to achieve your primary goal? *

Yes No Other

What is your target date?

Why is this date meaningful to you?

That's completely fine — what's your general timeframe?

Have you worked with a coach before? *

Yes No Other

What was your experience like?

What worked well, and what didn't?

What made you decide to seek coaching now?

05 Training

Daily activity level *

SedentaryDesk job, little to no intentional exercise Lightly ActiveLight exercise or walking 1–3 days/week Moderately ActiveModerate exercise 3–5 days/week Very ActiveHard training 6–7 days/week or physical job

Training days per week *

Average session duration *

Preferred training time

Current training split

06 Health & Mental Wellbeing

Have you been diagnosed with any health conditions? *

Yes No Other

List conditions

Approximate date of diagnosis

How does this condition currently affect your daily life or training?

Have you had surgery in the last year? *

Yes No Other

Type of surgery

Date of surgery

Are you fully cleared for exercise by your doctor?

Yes, fully cleared Not yet / Partial restrictions

Do you have any known cardiovascular symptoms? *

Yes No Other

Please describe your symptoms

Do you have any other symptoms of distressed health? *

Yes No Other

Please describe

Are you currently taking any medications or supplements? *

Yes No Other

List medications / supplements

Mental Wellbeing

How would you describe your current mental health? *

Good OK / Mixed Struggling

Would you like to share more?

Have you experienced anxiety or depression? *

Yes No Other

Is this currently being managed? How so?

How would you describe your overall mindset when it comes to your health and body? *

How confident are you in your ability to reach your goals? *

5

1 — Not at all10 — Fully confident

Are there any emotional or psychological barriers you feel may affect your progress?

07 Recovery

Average hours of sleep per night *

Sleep quality *

5

1 — Very poor10 — Excellent

Sleep consistency *

5

1 — Very irregular10 — Very consistent

08 Anything Else?

Is there anything else you'd like your coach to know?

How did you hear about us?

Coach Match Profile

Profile Received