Client Intake Form Name Email Phone Age Please list any current diagnosis or health concerns. List current medications, supplements, or hormones. List any past surgeries or major medical history. List any allergies or food sensitivities. What is your average sleep per night and quality? What is your stress level? What are your main stressors? What is your current movement and exercise routine? List any alcohol, caffeine, or nicotine use. Please describe your current diet. What are your biggest nutrition struggles right now? Goals What is your biggest barrier to progress? Complete the Intake Form