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Intake Form

The document is an intake form for online coaching at SportFit, filled out by Moipone Mahlako, a 22-year-old female hockey striker. It includes personal information, current fitness level rated at 8, medical history with a past knee surgery, and prompts for exercise history, nutrition, and lifestyle details. The form aims to gather comprehensive information to tailor the coaching program to the client's needs.

Uploaded by

Moipone Mahlako
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17 views2 pages

Intake Form

The document is an intake form for online coaching at SportFit, filled out by Moipone Mahlako, a 22-year-old female hockey striker. It includes personal information, current fitness level rated at 8, medical history with a past knee surgery, and prompts for exercise history, nutrition, and lifestyle details. The form aims to gather comprehensive information to tailor the coaching program to the client's needs.

Uploaded by

Moipone Mahlako
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

Welcome to SportFit!

Please fill in this form with as much information as possible. The more we get to know
about you, the better we can accommodate your preferences and tailor the program to
your needs!

Online Coaching Client Intake Form

Personal Information:

Name: Moipone Mahlako

Age: 22

Gender: Female

Email: moiponemahlako23@gmail.com

Phone Number: 068 271 7236

Sport and position: Hockey (Striker)

Relatively comfortable.

Current Fitness Level: Ye s, I have worked with a S&C Coach.

How would you rate your current fitness level (on a scale of 1 to 10, with 1 being
sedentary and 10 being highly active)?
• 8

Medical History:

Do you have any existing medical conditions or injuries that may affect your training?
If yes, please provide details.
• No

Are you currently taking any medications? If yes, please provide details.
• No

Have you ever had any surgeries related to fitness injuries? If yes, please provide
details.
• I underwent an arthroscopic knee surgery to repair a type 3 ACL avulsion fracture

Have you had any significant health issues in the past year?
• No
Exercise History:

How comfortable are you in the gym? Have you worked with a S&C Coach or
Personal Trainer before?

What type of physical activities have you participated in before (e.g., gym, running,
cycling, swimming, etc.)?

How many hours per week do you currently spend on physical activities (name
hockey and gym?

Are you currently following a training plan? If yes, please provide details.

Nutrition:

How would you describe your current eating habits?

Do you have any dietary restrictions or allergies?

What do you typically eat before, during, and after your workouts and matches?

Lifestyle:

What is your occupation/Course of study?

How many hours do you typically work/study per week?

Do you have any significant stressors in your life (e.g., family, work, etc.)?

How many hours of sleep do you get on average per night?

Additional Comments:

Feel free to provide any other relevant information or questions you may have.

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