Revitalize U Fitness — Intake Form REVITALIZEU Fitness Client Intake Form 01 Personal Info Full Name * Please enter your full name. Age * Please enter your age. Current Weight * Please enter your current weight. Height * Please enter your height. 02 Goals & Schedule Primary Goal * Lose body fat while maintaining muscle Build lean muscle while staying lean Improve overall performance and recovery General health and body composition improvement Please select your primary goal. Training Days Per Week * 3 days 4 days 5 days Please select how many days per week you can train. Where Do You Primarily Train? * Commercial gym Home gym Both Outdoor Please select where you train. 03 Training Background How Long Have You Been Training Consistently? * Less than 6 months 6 months to 1 year 1 to 3 years 3 or more years Please select how long you've been training. How Would You Describe Your Training Experience? * Beginner — still learning movements and building base Intermediate — comfortable with most exercises, training regularly Performance adjacent — been training seriously, want to optimize Please select your experience level. Are You Currently Following a Structured Program? * Following a structured program Training on my own with a general plan No real structure right now Please select your current program status. What Does Your Current Training Split Look Like? 04 Recovery & Lifestyle What Time Do You Typically Go to Sleep on Weekdays? * Please enter your typical sleep time. What Time Do You Typically Wake Up? * Please enter your typical wake time. How Would You Rate Your Current Sleep Quality? * Consistently good — I wake up feeling rested Hit and miss — some good nights, some bad Poor — I rarely feel recovered in the morning Please select your sleep quality. How Would You Describe Your Stress Levels Outside of Training? * Low — generally manageable Moderate — some consistent pressure but handling it High — regularly elevated and affecting daily life Please select your stress level. What Is Your Current Occupation or Daily Activity Level Outside of Training? * Desk job — mostly sedentary outside of workouts On my feet — active job or lifestyle High demand — physically or mentally taxing daily Please select your daily activity level. 05 Nutrition Are You Currently Tracking Your Food in Any Way? * Yes, consistently Sometimes No Please select your food tracking status. Do You Have a General Sense of How Many Calories You Eat Daily? * Yes, I have a solid idea Roughly, but not precise No idea Please select your calorie awareness level. How Would You Describe Your Current Eating Habits? * Pretty dialed in — consistent meals, hitting protein, minimal junk Decent — some good habits but inconsistent Needs work — eating is all over the place Please select your eating habits. Do You Have Any Dietary Restrictions or Allergies? * Please enter your dietary restrictions or 'none'. 06 Cycle Do You Have a Regular Menstrual Cycle? * Yes, regular Irregular No cycle currently On hormonal birth control Please select an option. Do You Currently Track Your Cycle? * Yes, with an app Loosely — I have a general idea No Please select an option. 07 Whoop Do You Currently Own a Whoop? * Yes, and I wear it consistently Yes, but inconsistently No Please select your Whoop ownership status. A Whoop Is Required for This Program. Are You Open to Getting One? * Yes, I'm open to it I need to understand the cost first Please select an option. 08 Final Questions What Have You Tried Before That Hasn't Worked the Way You Expected? * Please share what hasn't worked for you. What Does Success Look Like for You at the End of Four Months? * Please describe what success looks like for you. Send to Coach Ravonn This will open your email app with your responses pre-filled.
