Strong & Well · Your Starting Point

Welcome

Who is completing this form?

Preferred name

Contact email (optional)

Where are you in your journey?

Your privacy matters.This pilot does not upload answers to the database or store them in browser storage. At the end, you can download a private intake file for your coach. Do not share sensitive files using public links.

Your goals and your why

Primary goal

What would achieving this goal make possible for you?Do you have a target weight or measurement? (optional)If you chose a number, what does it represent to you?What don't you want to sacrifice to achieve your goal?

Training that fits your life

Realistic strength-training days per week

Minutes per session

Experience

Training location

Preferred training days and schedule constraintsAvailable equipmentExercises you enjoy or prefer to avoid

Movement and readiness

These questions help your coach plan responsibly. They aren't a diagnosis or medical clearance.

Any exercise-related chest discomfort, fainting, unusual breathlessness, or other symptoms needing medical attention?Pain, injuries, surgeries, current care, movement concerns, or accommodations you want your coach to know about (optional)Movements that feel difficult or that you'd like to improveWhat kind of start feels manageable?

Your coach will review screening answers before prescribing exercise.

How you'd like to be coached

What kind of feedback helps most?What tends to get in the way of consistency?What would you like to track? (optional)Additional notes / coach observations (optional) I understand this is a draft intake for coach review, not enrollment, medical clearance, or an automatically approved program.

Next step: Download the intake JSON and share it privately with your coach. The included 12-week phase outline contains no invented exercises or weights.