Ignite — Launchpad Intake (Coach)

Pulled from the client's chart. Name, date of birth, program and GLP-1 status are filled in automatically — you don't retype what the system already knows. Correct anything that looks wrong and it writes back.

Session

Client

Date of birth

Launchpad date

Coach

Program

Program start

On GLP-1 / medical program

Referred by

Section 1

Ultrasound body composition

BodyMetrix BX2000. Take each site twice; if two readings differ by more than 2 mm, take a third.

Height

Weight (lb)

Body fat %

Fat mass (lb)

Lean mass (lb)

Protocol used

1-site3-site 7-siteOther

3-site — men: chest, abdomen, thigh. Women: triceps, suprailiac, thigh.

Section 2

Circumference

Nearest ¼ inch. Tape snug, not compressing. Same landmarks every re-scan.

Neck

Shoulders

Chest

Waist at navel

Bicep

Thigh

Calf

Hips (widest)

Left / right differences or asymmetries

Section 3

Training history & goals

Experience & current activity

Training experience

New / returning after 1+ yrSome (<2 yrs) Experienced (2+ yrs)Advanced / former athlete

Currently active

Not at all1–2 days 3–4 days5+ days

Comfortable with

BarbellDumbbellMachines CablesKettlebellConditioning None of it yet

Days per week available

Preferred times

Plan around anything?

Injuries, surgeries & concerns

Area / injury

When

Still symptomatic?

Cleared by a provider?

What makes it worse

Movements they're nervous about or told to avoid

Currently under care? (PT, chiro, ortho, pain management) — who and for what

Goals — in the client's own words verbatim

Primary goal — the one that matters most

Secondary goals

What does six months from now look like? What changes in their life?

What have they tried before, and why did it stop working?

Non-scale win they care about

Target date / event

Confidence 1–10

Section 4

Movement & injury screen

General fitness screen — not a physical therapy evaluation or a diagnosis. Note asymmetry every time you see one; it drives the program more than the score does.

Screen summary

Top three limitations to program around

Program modifications for week one

Provider review required before loadingYou scored at least one station REFER. This routes to the client's physician or Ignite's provider before that work is loaded.

Provider review reason

Section 5

Nutrition bridge

A bridge, not a re-ask. The left column is already on file from their intake form — confirm or correct it, don't ask it again.

Item	On file from intake	Confirmed / corrected today
Typical day of eating	pulled from Form B
Meals per day / window	pulled from Form B
Protein habit	pulled from Form B
Alcohol	pulled from Form B
Sleep (hrs / quality)	pulled from Form B
Water	not asked on Form B
Meals out per week	pulled from Form B
Supplements	pulled from Form B
Cooks at home / who shops	pulled from Form B

Follow-up questions you asked — and what they said

Barriers the client named, in their own words

For the nutrition coach — not delivered to the client today

Nutrition session scheduled

Nutrition coach assigned

Within 14 days?

Provider review flags — route before any nutrition change

History of disordered eatingDiabetes (any type) Pregnant / postpartum / TTCPhysician-prescribed diet GI conditionKidney disease Cardiovascular conditionOn a GLP-1 / GIP program

Other

Nutrition provider review requiredRoute to the provider before any nutrition change is made.

Section 6

Wrap-up

The chart-transfer checklist is gone on purpose. On paper it existed because a person had to retype all this into HubSpot and tick off what they'd done. Submitting this form does the transfer — measurements, screen scores, goals and flags all land on the chart, and the PDF attaches itself. Nothing to check off, nothing to forget.

What the client is walking out with

Re-scan scheduled for

Date

Coach signature

Sign here

Printed name

The movement screen on this worksheet is a general fitness assessment performed by an Ignite coach. It is not a physical therapy evaluation, a diagnosis, or medical treatment. Ignite coaches are not physical therapists, athletic trainers, or licensed medical providers in their coaching role. Any station scored REFER, and any provider review flag checked, routes to the client's physician or to Ignite's provider before that work is loaded or before nutrition changes are made.