Ignite — Fitness, Injury & Nutrition Intake

Section 1 of 5

Health screen

Answer honestly. A "yes" doesn't disqualify you from anything — it tells your coach where to be careful, and may mean we ask your physician to sign off first.

PAR-Q screen

Standard pre-exercise screening. Ten questions.

Has a doctor ever told you that you have a heart condition, or that you should only do physical activity recommended by a doctor?

Do you feel chest pain when you do physical activity?

In the past month, have you had chest pain when you were not doing physical activity?

Do you lose your balance because of dizziness, or ever lose consciousness?

Do you have a bone, joint or soft-tissue problem that could be made worse by physical activity?

Is your doctor currently prescribing medication for blood pressure or a heart condition?

Are you currently pregnant, recently postpartum, or trying to conceive?

Do you have a current or past diagnosis of an eating disorder, disordered eating, or body-image disorder?

Any other medical condition, injury, surgery (past or planned), or symptom that may affect safe exercise or nutrition?

Are you taking any medication, peptide, GLP-1/GIP product, HRT or supplement that may affect exercise tolerance, hydration, blood sugar or cardiovascular response?

We'll follow up on thisYou answered yes to at least one item. Your coach may modify your program or ask for written physician clearance before you start. Add detail below so we know what we're working with.

Details for anything you answered yes to medical_concerns

Section 2 of 5

Your goals

What are your health and fitness goals? Be specific. "Get in shape" gives your coach nothing to work with — "deadlift 315 and fit my old jeans by spring" does. primary_goal_category (bucketed)

What's your time frame?

Why do these matter to you? How does your life improve if you get there? This is the one your coach comes back to when you want to quit in week nine.

What's gotten in the way before?

Section 3 of 5

Training history

Heightheight

Current weightweight

How would you describe your current activity level? current_activity_level

✓Very active

✓Moderately active but inconsistent

✓Rarely active, but ready to change

✓Not active

What's your current routine? If you're not training now, what have you done before — and when did you last train consistently? years_of_training_experience

Do you track your workouts — sets, reps, weight?

✓Yes, consistently

✓Sometimes

✓No

How many days a week can you realistically commit? Realistically. Not aspirationally. strength_training_frequency

Section 4 of 5

Injuries & limitations

Any injuries or issues we should design around? injury_history

Do any of these cause you pain? Check all that apply

✓Squatting

✓Bending

✓Overhead reaching

✓Walking

✓Running

✓Stairs

✓Sitting for a while

✓None of these

Are you under the care of a physician, chiropractor or other health professional for anything?

Anything you already know you shouldn't do?

Section 5 of 5

Nutrition & lifestyle

Your coach uses this to build something you'll actually follow, not a plan that looks good on paper.

Any allergies, intolerances or sensitivities? patient_allergies

Foods you dislike or won't eat

Currently taking any supplements?

Alcoholic drinks per weeksocial_history

Restaurant / fast-food meals per week

What line of work are you in? Is it mostly sedentary? social_history

How's your sleep? Hours per night, and quality

Are you under a considerable amount of stress right now?

✓Yes, a lot

✓Some, manageable

✓Not really

How would you rate your cooking skills?

✓Confident — I cook most nights

✓I can follow a recipe

✓Basic — eggs and a grill

✓I don't cook

Have you meal prepped before? Batch cooking for several days at a time

✓Yes, regularly

✓Tried it, didn't stick

✓Never

Write down everything you ate yesterday, in detail Including drinks and anything you grazed on. Nobody's judging — this is a starting point, not a test.

Before you submit

Everything here goes into your chart so your coach and your provider are working from the same picture. Let us know when something changes — a new injury, a new medication, a new diagnosis.

Your name

Date