Client Intake Form — Born Bad

01 / Personal Information

Full Name

Preferred Name

Age

Date of Birth

Phone Number

Email Address

City / State

02 / Body Stats

Current Weight

Height

Goal Weight

Clothing Size

07 / Accountability

How do you handle hard days?

What keeps you going when motivation is low?

Preferred check-in method

♡Text

♡Voice note

♡FaceTime

♡Zoom

Best day for your weekly check-in

By submitting this form you confirm the information is accurate to the best of your knowledge. Your coach is not a licensed medical provider. Always consult your physician before starting any new fitness or nutrition program.

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You're all set!

Your coach will review everything and be in touch with your plan soon. Stay ready.