Intake & Assessment Form

WELCOME TO YOUR NEXT STEP!

Now that you have made a committment to begin coaching, we are going to ask you form some information so we can connect you with the Coach Me Strong coach best suited for you individual needs.

This information is confidential and is protected and encrypted according to HIPAA standards. Only the Coach Me Strong management team and coaches have access to this information. You can expect us to contact you within 48 hours to review your information, talk through any additional concerns, then recommend one or more coaches. You are then welcome to contact each of our coaches prior to making a final decision on who will be your new coach.

Please contact us anytime with any questions.

Ready for step two? LET’S GET GOING!

  • GENERAL INFORMATION

  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • MEDICAL HISTORY

  • Date Format: MM slash DD slash YYYY
  • Please tell us a little about your current exercise routines:

  • Coach Me Strong General Release of Liability and Covenant Not to Sue