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Team Mel: Health & Readiness Intake Form

Before We Begin:

Your health comes first. Please answer the following questions as accurately as possible so I can understand anything that may affect your training, nutrition, recovery or overall coaching plan.

This information helps me coach within my scope and make appropriate programming decisions. It does not replace medical care or advice from your physician or other healthcare provider.

Today's Date

Full name

Email address

Do you currently have any diagnosed medical conditions that may affect your training, nutrition, energy, recovery or body composition?

A
B
C

If yes or unsure, please tell me about any relevant medical conditions. Include anything you believe I should know, even if it is currently well-managed.

Please describe any current injuries, pain or physical limitations.

Are there any previous injuries or surgeries that still affect how you train or move today? Please include approximate dates where possible.

Do any of the following movements currently cause pain, discomfort or concern?

If you selected any movements above, describe what you experience and where you feel it. If none, enter N/A.

Have you had surgery or a medical procedure within the last 12 months, or do you have one scheduled?

A
B

If yes, please provide the procedure, approximate date and any current restrictions or recovery considerations. If none, enter N/A.

Has a healthcare professional given you any restrictions or recommendations regarding exercise?

A
B

If yes, please explain the recommendations or restrictions. If possible, include how long they are expected to remain in place.

Has a healthcare professional given you any restrictions or recommendations regarding nutrition?

A
B

If yes, please explain. If none, enter N/A.

Please list all prescription medications you currently take. Include the medication and dosage if known. If none, enter N/A.

List all supplements/dosages you currently take (vitamins, minerals, protein powders, creatine, pre-workout, sleep products, herbal products, anything you use regularly).

If applicable, which best describes your current menstrual/reproductive stage?

Is there anything else about your health, hormones, medications, recovery or medical history that you think would help me coach you safely and effectively?

TEAM MEL COACHING - TERMS ACCEPTANCE

Please review the Team Mel Coaching Ltd. Terms of Service, Client Policies & Professional Standards before continuing:
https://www.teammel.ca/termsofservice

I confirm that I have read, understood, and agree to the Team Mel Coaching Ltd. Terms of Service applicable to the coaching service I purchased.

I confirm that I have read, understood, and agree to the Team Mel Coaching Ltd. Client Policies & Professional Standards applicable to the coaching service I purchased.