Embody Health and Fitness Intake Form

First name

Last name

Email

Phone Number

How do you prefer to be contacted?

Text Message

Phone Call

Birthday

Month

Day

Year

City and State you live in:

Which program you are most interested in signing up for?

Embody Community comes with:

Updated macro count anytime you need or want
Weekly check-ins and accountability with our coaches
Access to ask questions anytime
3-4 new recipes a week
Workout of the day (this isn't specific to your goals just a generic workout you can do each day)
Nutrition tips and education
Full access on our app. Gives you a place to track goals, log your workouts, has videos on how to do exercises, track body measurements, track weight, see side by side progress pictures, and track your overall progress

What is your height in inches?

What is your weight?

What is your gender?

What are your health goals?

How many calories/day are you currently eating?

Do you have experience in tracking macros?

Do you have access to a gym?

What is your current workout routine? (I.e. lifting, cardio, HIIT, how many days/wk.)

How many days a week do you plan to workout when starting the plan (this will affect the calories and macros we calculate for you)?

Do you have health issues I should be aware of?

If we are creating a meal plan for you, please list any foods you hate or food allergies:

If we are creating a meal plan for you, list your top 3 favorite healthy carbs:

If we are creating a meal plan for you, list your top 3 favorite healthy fats:

If we are creating a meal plan for you, list your top 3 favorite healthy proteins:

If you plan to do a meal plan, are you going to be wanting coffee included in your plan? If so, are you open to sweetening it with a protein shake (fairlife, orgain, premiere) or protein powder? (If not, please list exactly how you make it).

How well do you sleep at night? How many hours do you get on average?

Do you prefer to work with a male or female trainer/coach?

Male

Female

I don't have a preference

Is there anything else you think we should know as your coach?

How did you hear about us?

What is your Instagram handle?

If you end up signing up for a program, are you okay with us sharing screenshots of your positive messages/wins you have/things you have learned on our social media?

Promo Code

I acknowledge that once your full plan has been delivered, refunds are not offered.

I have read and agree to the Waiver of Liability and Release Agreement

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