Client Information Form

Client Assessment Form

So you’ve flipped the switch and want to transform your life! Please fill out this detailed form so that the team can prepare a tailored plan for you.

Step 1 of 9

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Name & Surname(Required)

Contact No(Required)

Email(Required)

Number of children(Required)

Marital Status(Required)

General

Age(Required)

Body Fat%(Required)

Weight(Required)

Height(Required)

Lifestyle

What do you do for a living?(Required)

How many hours per day do you work?(Required)

How many days per week do you work?(Required)

How long is your commute to work?(Required)

On a scale of 1-10 would you rate your work stress?(Required)

On a scale of 1-10 how would you rate your sleep?(Required)

What is your quality of sleep like?(Required)

Training

What training methodologies have you followed in the past?(Required)

Eg. Pilates / Yoga / CrossFit / Powerlifting / GPP / Bodybuilding / General exercise & fitness?

How many years have you been exercising?(Required)

What are your biggest struggles/weaknesses with exercise?(Required)

What are your physical goals, be objective, be specific, make them attainable, we want to know everything about where you want to be physically?(Required)

What gym will you be training in and what equipment will you have access to, please be specific regarding machines, free weights, cardio equipment, conditioning equipment etc?(Required)

How many days a week are you able to train?(Required)

How many hours per day are you able to dedicate to your training?(Required)

Injuries / Conditions / Illness

Please list ALL injuries you have suffered with in the past, whether they be mild or major (inclusive of personal or sports related, i.e.: broken left femur sustained in car accident, sprained ankle from fall on stairs or torn rotator cuff from bench pressing). Please include any physical conditions you may suffer with, i.e.: scoliosis, spondylosis. Please include any illnesses you are currently suffering from, i.e.: arthritis, cancer, asthma, bulimia:(Required)

Do you have any musculoskeletal issues? Screenshot the below image, circle the below graphs as follows and upload in the button below if applicable:

Upload Graph

Max. file size: 1 GB.

Give us some more information here: What caused the injury? Is it better or worse? What kind of pain do you experience (bruising/pinching/radiation)? Give us a brief explanation on the above graph if applicable:

Flexibility test

Please complete this 9 point flexibility test. Score 1 if you are able to perform the movement, and 0 if you cannot:

Left finger score:(Required)

Right finger score:(Required)

Left thumb score:(Required)

Right thumb score:(Required)

Left elbow score:(Required)

Right elbow score:(Required)

Right knee score:(Required)

Left knee score:(Required)

Bend score:(Required)

Total score out of 90:(Required)

Nutritional Assessment

What are your physical goals? Weight loss, fat loss, muscle gain, performance?(Required)

What diets have you followed in the past?(Required)

Do you make use of steroids? If so, please list dosages:(Required)

What supplements do you make use of?(Required)

Are you currently on any medications? If so please list:(Required)

Is your menstrual cycle regular?(Required)

Do you use alcohol? If so how often?(Required)

What are your religious practices?(Required)

Do you have any food allergies?(Required)

What are your preferences e.g. vegetarian, pescatarian, vegan?(Required)

What do you struggle the most with when it comes to your nutrition?(Required)

Are you a very social person (enjoy frequent social events)?(Required)

Do you have any foods that trigger you or foods that you just cant say no to?(Required)

What foods are your least favorite?(Required)

Do you prefer carbs or fats? For example do you immediately reach for starchy food (bread) or fattier food (cheese):(Required)

What do you prefer when dieting? Low carb or high fat or what are your preferences and tell us why:(Required)

What is your relationship with food like? Do you see some foods as good or bad?(Required)

Do you have any history with food dysmorphia or body image dysmorphia (you see yourself as bigger or smaller than you actually are or a fixation on the number on the scale):(Required)

Do you suffer with any digestive issues like IBS?(Required)

How many steps are you currently getting in a day according to your tracker, if you are tracking?(Required)

Have you had any blood work done in the last 12 months? If so, please could you submit your results with this form:

Max. file size: 1 GB.

Please could you complete a 48 hour dietary recall of the last 2 days:(Required)

Measurements

Measure circumference of relaxed bicep at exact midpoint between shoulder bone and elbow. Measure both left and right and side and complete below:(Required)

Measure circumference of widest part of chest, directly over the nipple.(Required)

Measure the circumference of waist, directly over belly button.(Required)

Measure the circumference of hips, directly over widest part of bum.(Required)

Measure the circumference of thighs, directly around widest part of thigh. Measure both left and right and side and complete below:(Required)

Measure the circumference of calves, directly around widest part of calf. Measure both left and right and side and complete below:(Required)

What is your bodyweight first thing in the morning?(Required)

What is your bodyweight just before bed?(Required)

Photos

Forward full-length photos holding today's newspaper for date reference. Please only wear a sports bra, bikini top and bottoms or shorts.

📸 Trouble uploading your photos? This is common on iPhones — no problem! These photos are now OPTIONAL, so you can still submit the form. Just email your 3 photos (front, side & back) to lil@otgathletic.co.za and we'll add them to your file.

Front photo

Accepted file types: jpg, jpeg, png, Max. file size: 10 MB.

Side photo

Accepted file types: jpg, jpeg, png, Max. file size: 10 MB.

Back photo

Accepted file types: jpg, jpeg, png, Max. file size: 10 MB.