Client Intake Form Template for Gut Health & Fitness

Use in FirstRep form

Personal Information

Collecting personal info helps tailor gut health solutions.

Aa Name *

Enter your full name

# Age *

Enter your age

Aa Email *

Enter your email address

Medical History

Understanding your medical background is crucial for gut health.

Y/N Do you have any diagnosed digestive disorders? *

... List any medications or supplements you are currently taking.

Enter your medications/supplements

Y/N Have you experienced GI distress during exercise? *

Dietary Preferences

Identifying your dietary habits helps in creating a suitable plan.

vv Do you have any food sensitivities?

Select all that apply

... What does a typical day's meals look like for you? *

Describe your meals

1-10 How often do you experience bloating? *

Rate from 1 (never) to 10 (always)

Exercise Habits

Understanding your fitness routine aids in gut health management.

vv What type of exercise do you regularly participate in? *

Select all that apply

# How often do you workout per week? *

Enter number of days

Y/N Do you have any pre-workout nutrition routines?

Gut Health Goals

Setting clear goals helps in tracking your progress effectively.

... What are your top three goals related to gut health? *

List your goals

1-10 How committed are you to improving your gut health? *

Rate from 1 (not committed) to 10 (very committed)

Why Use This Template

Tailored Assessments

Helps to create personalized gut health plans based on individual needs.

Identify Triggers

Aids in pinpointing food sensitivities and GI distress factors.

How to Use

Fill out all sections thoroughly to ensure accurate assessments.

Use the information to guide your nutrition and workout plans.

Customization Tips

Add fields for specific foods that cause discomfort.
Include a section for tracking symptoms post-workout.
Customize the form's design to reflect your brand colors.

Build and send gut health & fitness templates digitally with FirstRep. Free for up to 3 clients.

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Frequently Asked Questions

What should I do if I experience discomfort during exercise?

It's essential to communicate this with your coach to adjust your routine.

Can I still exercise if I have IBS?

Yes, but modifications may be necessary to accommodate your symptoms.