New Client Intake FormPlease fill this out so Coach Em knows how to best serve you and help you reach your goals. Name * First Name Last Name Date * MM DD YYYY DOB * MM DD YYYY Height * Weight * Health Care Provider * Phone * (###) ### #### Emergency Contact Name * Emergency Contact Phone #: * (###) ### #### Tell me the equipment you have access to in as much details as possible. * Home or Gym workouts? * Home Gym Do you have any physical limitations or medical problems that I should know about that would affect your ability to do certain workouts? * Do you have any experience counting macronutrients or any limitations you know of that would affect you ability to hit certain macronutrients? * Tell me your SPECIFIC goals for your body and what you want to achieve with me. * Do you agree that by submitting this document, this will take the place of your signature. * I agree Thank you!
