Skip to Content

Folder: Services

Let’s Work Together

If you're interested in working with us, complete the form with a few details. We'll review your message and get back to you within 24 hours.

Personal Training and Nutrition Client Intake Questionnaire

Reloaded & Redefined Performance Optimization™

Client Intake Questionnaire

Please complete this form in full so we can build a personalized strategy around your body, goals, lifestyle, and performance.

Personal Information

Full Name

Age

Height

Email Address

Phone Number

Instagram Handle

Facebook Profile or Name

Body Metrics & Goals

Current Weight

Please weigh first thing in the morning after using the restroom on Day 1.

Goal Weight

Why is this your desired goal weight?

Have you previously been at or near this weight?

If yes, when?

Current Body Fat Percentage

When was the last time you felt confident and comfortable in your body?

What are your biggest concerns regarding how you currently look and/or feel?

Lifestyle & Behavioral Patterns

Please check all that apply:

Fast eater Enjoy cooking Negative relationship with food Strong appetite / love to eat Erratic eating patterns Emotional eating Overeating tendencies Frequent fast food consumption Sweet cravings Late-night eating Often eat alone Confusion around nutrition Household has differing food preferences Reliance on convenience foods Poor snack choices Frequent travel Vegan / Vegetarian High-protein / Carnivore approach Gluten sensitivity or allergy Dairy sensitivity or allergy Standard American diet

Additional lifestyle details we should know

Sleep & Recovery

Do you wake during the night?

If yes, how often and why?

Overall sleep quality

0 = poor, 5 = excellent

Average hours of sleep per night

Daily Routine

Please outline your typical weekly schedule (work, family, commitments)

Please describe a typical day of eating, including approximate times

Nutrition & Hydration

Do you drink soda? If so, how often?

Do you consume caffeine? If yes, how much and how do you take it?

How much water do you drink daily?

Do you use a water bottle? If yes, what size?

How frequently do you consume alcohol?

How often do you eat out?

Health & Medical Information

Do you have any current or past health conditions we should be aware of?

Please list any medications you are currently taking

Please list any supplements you are currently taking

Are you currently using or have you previously used a GLP-1 medication?

If yes, please specify

Exercise & Training History

Are you currently exercising?

If yes, what type and how often?

How consistent have you been with training over the past 6–12 months?

Diet History & Experience

Have you followed any structured diets or nutrition plans in the past?

What has worked well for you?

What challenges have you experienced in maintaining results?

Home Environment & Support

Who is primarily responsible for grocery shopping?

Who is primarily responsible for cooking?

Do you have a supportive partner, family, or household environment?

Additional Considerations

Are you currently pregnant or breastfeeding?

Is there anything else you would like us to know about your lifestyle, habits, or goals?

Client Commitment

Are you ready to prioritize your health and performance?

Are you willing to follow a structured plan and make lifestyle adjustments?

What does success look like to you beyond the scale?

Home

✳︎

Fitness

✳︎

Nutrition

✳︎

Events

✳︎

Home ✳︎ Fitness ✳︎ Nutrition ✳︎ Events ✳︎

Located in Arizona | Mobile + Virtual Options

Contact

623-695-4489

info@reloadedandredefined.com

Reloaded and Redefined Wellness, LLC

Follow us on Social

Copyright by Reloaded and Redefined Performance Optimization -

All Rights Reserved