Client Intake Form Template for Sleep & Fitness Optimization

Use in FirstRep form

Personal Information

Gathering basic information helps tailor sleep and fitness strategies.

Aa Full Name *

Enter your full name

Aa Email Address *

Enter your email address

# Age *

Enter your age

Aa Occupation *

Enter your occupation

Sleep Patterns

Understanding your sleep habits is crucial for optimization.

# Average Sleep Duration (hours) *

Enter average hours of sleep

1-10 Sleep Quality Rating *

Rate your sleep quality

vv Sleep Environment *

vv Common Sleep Disruptors

Fitness Routine

Your workout schedule can greatly impact your sleep.

# Current Workout Frequency (days/week) *

Enter how many days you work out

v Workout Timing *

vv Types of Exercises

... Post-Workout Routine

Describe your post-workout routine

Technology and Sleep

Screens can significantly affect your sleep quality.

# Average Daily Screen Time (hours) *

Enter average hours of screen time

Y/N Screen Usage Before Bed *

vv Devices Used Before Sleep

Health and Lifestyle

Lifestyle choices play a crucial role in sleep and performance.

# Caffeine Intake (cups/day)

Enter how many cups of caffeine you consume

# Alcohol Consumption (drinks/week)

Enter average drinks per week

1-10 Stress Level *

Rate your current stress level

... Health Conditions

List any health conditions affecting sleep

Sleep Supplements

Understanding use of supplements is important for safety and effectiveness.

Y/N Currently Taking Sleep Supplements *

vv Types of Supplements Used

1-10 Effectiveness Rating

Rate the effectiveness of your supplements

Why Use This Template

Identify Sleep Issues

Understanding your sleep patterns and disruptions helps us create a tailored plan.

Connect Sleep and Fitness

Recognizing how your workouts affect sleep can enhance recovery and performance.

How to Use

Fill out each section as thoroughly as possible for accurate assessment.

Submit the form to receive personalized recommendations on improving sleep and fitness.

Customization Tips

Add specific questions related to individual client goals.
Include options for clients to elaborate on their answers.
Consider adding a section for client testimonials about sleep improvements.

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

Start for Free See All Features

Frequently Asked Questions

How long will it take to complete the form?

The form should take about 10-15 minutes to fill out completely, depending on your answers.

Will my information be kept confidential?

Yes, all information provided will be kept confidential and used solely for optimization purposes.