Welcome and Instructions for Completing Your Intake Form

Thank you for taking the time to complete this form. It’s designed to help me understand your fitness goals, mindset, and motivations, so I can create affirmations that resonate with you personally and support your journey.

Here are a few tips before you begin:

Be Honest and Authentic: This is a judgment-free zone. Share your thoughts, goals, and challenges openly to help me tailor affirmations that truly inspire you.
Take Your Time: There’s no rush to complete this form. Reflect on each question, and answer thoughtfully. The more detailed you are, the more personalized and effective your affirmations will be.
Focus on Positivity: Think about what excites and motivates you. This is an opportunity to focus on the future you want to create for yourself.
Dream Big: Don’t be afraid to set ambitious goals or envision your ideal outcomes. These affirmations will be tools to help you believe in and achieve them.

If you have any questions while filling out the form, feel free to reach out to me. I’m here to support you every step of the way.

Let’s get started on designing a mindset that matches your goals and sets you up for success!

Name

First Name

Last Name

Date

YYYY

1. What three long-term goals do you want to achive regarding your health and fitness?

2. Why are these goals important to you? What is it going to give you?

3. How do you want to feel when you reach your health and fitness goals?

4. What will be possible when you achieve your fitness goals that feel impossible now?

5. When you visualize your perfect body, what does that look like? Example: What will you be wearing? What will you be doing that you avoid doing now?

6. What can you change to feel better about yourself right now?

7. Can you love yourself just the way you are while in the process of transformation? Name three action steps you can take every day to love yourself.

8. What barriers or obstacles might keep you from reaching these goals?

9. What strategies can you put in place for overcoming these barriers?

10. What short-term goals can you set for yourself this week?

11. It's always important to show yourself self-love and to reward yourself for a job well done. What are a few ways you can reward yourself? Examples: bubble bath, go for a walk with a friend or family member, take a yoga call, get a massage or facial, time for yourself.

Welcome and Instructions for Completing Your Intake Form

Thank you for taking the time to complete this form. It’s designed to help me understand your fitness goals, mindset, and motivations, so I can create affirmations that resonate with you personally and support your journey.

Here are a few tips before you begin:

Be Honest and Authentic: This is a judgment-free zone. Share your thoughts, goals, and challenges openly to help me tailor affirmations that truly inspire you.

Take Your Time: There’s no rush to complete this form. Reflect on each question, and answer thoughtfully. The more detailed you are, the more personalized and effective your affirmations will be.

Focus on Positivity: Think about what excites and motivates you. This is an opportunity to focus on the future you want to create for yourself.

Dream Big: Don’t be afraid to set ambitious goals or envision your ideal outcomes. These affirmations will be tools to help you believe in and achieve them.

If you have any questions while filling out the form, feel free to reach out to me. I’m here to support you every step of the way.

Let’s get started on designing a mindset that matches your goals and sets you up for success!