Client Intake Form — Muscle by Mila

01

Basic Information

Full name *

Date of birth / age

Email address *

Phone number

Occupation

02

Goals & Experience

What are your primary fitness goals?

Select all that apply.

Lose body fat / Weight loss Build muscle / Hypertrophy Increase strength Improve cardiovascular endurance Improve flexibility and mobility General health and longevity Event prep Other

How would you rate your current fitness and weightlifting experience?

Beginner Intermediate Advanced

What physical activities or exercises do you currently enjoy?

What physical activities or exercises do you strongly dislike?

03

Body Metrics

All optional — only what you're comfortable sharing.

Current weight

Height

Estimated body fat %

Basal metabolic rate (BMR)

04

Health & Medical History

Any current or past injuries, surgeries, or chronic pain points?

Any medications or supplements I should be aware of?

Any medical conditions that affect your ability to exercise?

05

Availability & Commitment

How many days per week can you realistically dedicate to workouts?

1–2 days 3–4 days 5+ days

How much time can you commit to each session?

Under 30 minutes 30–45 minutes 45–60 minutes 60+ minutes

Where do you plan to work out?

Commercial gym Home gym Outdoors / No equipment

06

Lifestyle & Nutrition

Describe a typical day of eating (breakfast, lunch, dinner, snacks)

Current estimated daily calorie intake

How much water do you drink on an average day?

On average, how many hours of sleep do you get per night?

Less than 5 hours 5–6 hours 7–8 hours 8+ hours

How would you rate your daily stress levels? (1–10)

1 — Very low10 — Very high

Any dietary restrictions, food allergies, or eating preferences?

Are you interested in a customized nutrition plan to complement your training?

Yes, I'd like a structured meal plan Yes, but I prefer general macro/calorie guidance No, I have my nutrition handled

07

Final Thoughts

Anything else you think I should know to help you succeed?