Client Intake Form Template for Keto & Low-Carb Fitness

Use in FirstRep form

Personal Information

Collects essential details about the client for personalized coaching.

Aa Full Name *

Enter your full name

Aa Email Address *

Enter your email

# Age *

Enter your age

v Gender *

Keto Experience

Understanding your background with the keto diet helps tailor your plan.

# How long have you been on a keto diet? *

Enter duration in months

# Current Weight *

Enter your current weight in lbs

# Weight Goal *

Enter your target weight in lbs

vv Primary Reason for Keto *

Dietary Preferences

Helps in creating a meal plan that suits your taste and lifestyle.

... Favorite Foods

List your favorite keto-friendly foods

... Foods to Avoid

List foods you dislike or want to avoid

Y/N Any Allergies?

Exercise Habits

Understanding your current exercise routine is crucial for performance maintenance.

v Current Exercise Frequency *

vv Types of Exercise You Enjoy *

... Performance Goals *

Describe your performance goals

Health History

Gathering medical history helps in creating a safe and effective plan.

... Any Medical Conditions?

List any medical conditions you have

... Current Medications

List medications you are currently taking

... Past Injuries

Describe any past injuries affecting your exercise

Lifestyle Factors

Understanding your lifestyle helps in creating a sustainable plan.

Aa Occupation *

Enter your occupation

1-10 Average Daily Stress Level *

1-10 Sleep Quality *

Why Use This Template

Personalized Approach

Understanding your unique needs allows for tailored coaching.

Identify Challenges

Pinpointing pain points helps address specific issues effectively.

How to Use

Fill out all sections accurately to ensure the best coaching experience.

Submit the form to receive your personalized keto coaching plan.

Customization Tips

Add specific food preferences to personalize meal plans.
Include additional health questions for comprehensive assessments.
Tailor exercise habit questions based on client fitness levels.

Build and send keto & low-carb fitness templates digitally with FirstRep. Free for up to 3 clients.

Start for Free See All Features

Frequently Asked Questions

What if I am not currently on a keto diet?

This form can still help assess your fitness levels and dietary preferences.

How long will it take to get my customized plan?

You will receive your plan within 5-7 business days after submission.