The Flex Cult · Become a Gym Nutrition Coach
Client Intake & Nutrition Screening Form
Print and hand this to a new client before session one. This is an educational template — have it reviewed by a local professional before using it as a legal document.
Client Information
Full Name
Date
Phone / Email
Dietary Pattern (omnivore/vegetarian/vegan/other)
Red-Flag Screening
🚩 If the client answers YES to any question below, refer to a dietitian or mental health professional before coaching begins.
Do you regularly skip meals or restrict calories as a strategy?
Have you been diagnosed with, or are you currently in treatment for, an eating disorder?
Do you have a diagnosed condition requiring medical nutrition therapy (e.g. diabetes, kidney disease)?
Are you currently pregnant or breastfeeding with a specific medical nutrition concern?
Do you feel significant guilt, anxiety, or rigid "good/bad" rules around food?
3-Day Food Diary
DayBreakfastLunchDinnerSnacks
1
2
3 (weekend)
Lifestyle Context
Goals
Primary stated goal
What does achieving this actually mean to you? (the "why")
Behavior goal for this month (e.g. "hit protein target 5x/week")
Acknowledgment

I understand this coaching is general nutrition education and habit coaching, not medical advice, and does not replace care from a doctor or registered dietitian. I agree to inform my coach of any changes to my health status.

Client Signature
Date