Contact Information

First Name

This information will be used for me to reach out to you. Your contact information is confidential and will never be shared without your consent.

Last Name

Cell Phone

Street Address

City

State

Zip Code

Do you follow @calyxfit on Instagram?

Yes!

No, but I will

I don't have an Instagram account

Your Instagram Username

Personal Stats

Birthdate

This information will be used to build a baseline profile for you. It helps determine the best plan for your goals. If you are unsure of any of the information, give your best estimate.

Current Weight

If you do not know, give an estimated number. Please indicate lbs or kg

Height

If you do not know, give an estimated height. Please indicate ft / in / cm

Body Fat %

If known

How long have you been working out / training?

What is your occupation?

You may be general here, e.g. manager/personal trainer/IT/doctor. The aim is to characterize your circadian rhythm, stress and activity level.

Please list any pathologies and injuries you have or had.

Do you insist on any special diet?

Please list all supplements you’re currently taking.

Besides your occupation, what other regular commitments do you have?

Strength Levels

Bench Press

State your current maximum abilities in weight times reps, e.g. 250 lb x 6

Squat

Chin Ups / Pull Ups

Overhead Press

Current Efforts

Please describe your current diet plan in detail

Let's talk about what you are doing currently to meet your goals

Please describe your your current training program in detail

Fitness & Health Goals

What are your fitness goals?

Think about your overall fitness and health goals and articulate that here.

Do you have any muscle groups you do not want to get more muscular?

Do you want to perform any other form of exercise alongside strength training?

Which of the following options best describes your dedication level?

Sustainability is most important to me. As long as I’m moving in the right direction, I don’t care about the rate of progress.

I want to strike a reasonable balance between good results in proportion to effort and sustainability.

I will do whatever it takes to achieve maximum results without compromising my health.

How often in a week are you prepared to train for maximal results?

Lifestyle

Are there any times at which you are unable or unwilling to train?

When you choose to live a healthy lifestyle, your goals have a higher chance of becoming reality. The information below will help me guide you to a healthier lifestyle. If any question is too sensitive, feel free to ignore it, but the more information I have, the better I can help you.
This includes when you’re at work. If you don’t answer this question accurately with detailed times, you may get a program you can’t follow

Which of the following options best describes your day to day activity level aside from your planned training sessions?

Sedentary (e.g. office job)

Somewhat active (e.g. you walk your dog several times a day or you commute by bicycle)

Active (e.g. full-time PT, literally on your feet most of the day)

Very active (e.g. involved in manual labor)

Which of the following options best describes your stress level?

Stress-free (e.g. on holiday)

Only occasional/mild stress (e.g. student not during exam period)

Average stress (e.g. full-time work with deadlines and commuting)

High stress (e.g. very high-paced work environment with great responsibility)

How is your sleep rhythm and quality?

When you you go to bed, how fast do you fall asleep, and how often do you wake up and go back to sleep?

How many hours on average do you sleep a night?

I am a

Morning Person

Evening Person

Other

If other, how would you describe yourself?

How much caffeine do you consume daily on average or on a typical work day?

Do you have a regular menstrual cycle? And are you using any form of contraception?

If these questions are sensitive, feel free to ignore them, but the more information I have, the better I can help you.

Equipment

Do you have skinfold calipers and if so, what’s the brand and model?

Yes

The following questions will help me determine which equipment you have will be helpful in accomplishing your goals. Note: that you don’t need access to all of the equipment listed to have a good training program. I’m mainly asking for the more uncommon pieces of equipment here.

If yes, what brand and model?

What are the lightest barbell weight plates you have access to?

What are the smallest weight increments between the sets of dumbbells you have access to?

Does your available equipment differ from that in most gyms in any other way?

Genetics

Wrist circumference (smallest point)

Ankle circumference (smallest point)

How much did you weigh before you started lifting?

What was your height before you started lifting?

Were you heavy as a baby?

Yes

If you recently had blood work done, please attach the results

pdf, jpg, jpeg, png, heic, doc, docx · max 15MB · up to 10 files

Hand Photo

Back Right Hand Photo

jpg, jpeg, png, heic · max 15MB

Please upload a picture to this form in which the back of your right hand is clearly visible. Place your right hand on a flat surface with your fingers touching each other and then take a picture of it. You can also email the photos directly to shawnda@calyxfit.com

Full Body Photos

jpg, jpeg, png, heic · max 15MB · up to 5 files

Attach at least two full-body pictures of yourself in clear lighting (without excessive shadows; not your most flattering Facebook selfies), preferably including a back and front pose in posing attire or similar clothing. These photographs remain confidential and are to evaluate your current physique. You can also email the photos directly to shawnda@calyxfit.com

* Required field

Forms

Client Intake Form