Online Nutrition Coaching Intake Form

Your Privacy Matters

Because this form asks for personal health and lifestyle information, we treat everything you share here as confidential. Your responses are stored securely in our private system, are only accessible to Full Scale Fitness staff involved in your coaching, and are never sold or shared with third parties except as required by law. Please see our Privacy Policy and Nutrition Coaching Terms and Conditions linked at the end of this form for full details.

Contact & Basic Information

Please fill this out as completely and accurately as possible — it helps your coach personalize your program.

Full Name *

Email Address *

Phone *

Date of Birth *

Height

Current Weight

Typical Daily Activity Level

Health History

This information stays confidential and is only used to personalize your nutrition guidance safely.

Medical conditions, medications/supplements, and food allergies or intolerances *Please list any diagnosed conditions (e.g. diabetes, high blood pressure, thyroid, PCOS, heart or GI issues), medications or supplements you take, and any food allergies or intolerances.

Are you currently under the care of a physician or registered dietitian for any condition? *If yes, please briefly explain in the field above or let your coach know.YesNo

Anything else about your health history we should know?

Lifestyle

Sleep and daily routineHow many hours do you typically sleep, and how would you rate the quality? What does your daily routine look like — desk job, on your feet, shift work, etc.?

What does a typical day of eating look like for you right now?Walk us through meals, snacks, and timing on a normal day.

Tobacco and alcohol useDo you smoke or use tobacco products? Do you drink alcohol? If yes to either, how often?

Nutrition Goals & Preferences

What are your main goals for nutrition coaching? (select all that apply)Weight lossMuscle gain / strengthImprove energy and focusManage a health condition (e.g. diabetes, high blood pressure, PCOS)Athletic / sports performanceBuild sustainable healthy habitsOther

Your short-term and long-term goalsWhat would you like to accomplish in the next few weeks? What about the next several months?

Meal Prep Habits & Grocery BudgetWho typically cooks or handles groceries in your household? How much time do you realistically have to cook or meal prep each week? Any budget considerations we should keep in mind when planning your meals?

Foods you enjoy, foods you dislike, and past coaching experienceWhat foods do you love? What do you avoid or dislike? Have you worked with a nutrition coach or dietitian before — what worked and what didn't?

Coaching Preferences

Let us know how you'd like to stay connected throughout your program.

Preferred Check-In Method

How Often Would You Like Check-Ins?

Acknowledgment & Consent

Please review and confirm the items below before submitting.

Full Name (Type to Sign) *By typing your full name, you are electronically signing this intake form.

Date of Signature *

Let’s Build Your Nutrition Plan