Fitness Coaching Intake — U.S.M.C. Ministries

Personal Information

Let's start with the basics so Coach Moop can personalize your program.

First Name

Last Name

Age

Gender

Male

Female

Email

Phone

PAR-Q Health Screening

Physical Activity Readiness Questionnaire — standard NASM pre-screening. Please answer honestly.

Has your doctor ever said you have a heart condition?

Yes

No

Do you feel pain in your chest during physical activity?

Yes

No

Do you lose balance due to dizziness or lose consciousness?

Yes

No

Do you have a bone or joint problem that could be worsened by exercise?

Yes

No

Are you currently taking medication for blood pressure or a heart condition?

Yes

No

Is there any other reason you should not engage in physical activity?

Yes

No

⚠ Based on your answers, please consult a physician before beginning an exercise program. Coach Moop will still review your intake, but medical clearance is recommended before starting.

Known injuries, surgeries, or physical limitations

Movement & Training

Understanding how you move is just as important as what you lift. NEAT accounts for up to 30% of daily calorie burn.

Training Background

Primary training modality

fit20 / Slow Motion HIT

Barbell / Powerlifting

Weight Training / Machines

Cardio (Running / Swimming)

HIIT

Hiking / Outdoor / Other

Training experience level

Beginner (0–1 yr)

Intermediate (1–3 yr)

Advanced (3+ yr)

Sessions per week

0

1–2

3–4

5+

Current routine description

Daily Movement (NEAT)

Average daily steps

Under 5,000

5,000–8,000

8,000–12,000

12,000+

Occupation type

Desk / Sedentary

Active / Physical

Mixed

Body Composition

We focus on body composition — not just the scale. Visceral fat reduction and muscle retention are the real targets.

Current Stats

Height (inches)

Current Weight (lbs)

Waist Circumference (inches)

Body Fat % (if known)

DEXA, InBody, or home scale estimate.

Visceral Fat Score (if known)

Shown on InBody, Tanita, or Withings scales. Priority metric.

Goals

Goal Weight (lbs)

Primary goal

Fat Loss

Muscle Building

Body Recomposition

Performance

Longevity

Lifestyle / Maintenance

Additional goals

Visceral fat reduction

Strength

Endurance

Flexibility

Energy / Vitality

Pain Relief

Sports Performance

Mental Clarity

Nutrition Profile

Nutrition is 80% of body composition. Coach Moop will build a plan around your real habits — not an ideal that doesn't fit your life. Answer honestly; this data directly shapes your program.

Diet Overview

Overall diet quality right now

Poor

Fair

Good

Excellent

Unsure

Do you track calories?

Yes — daily

Occasionally

No

Used to

Estimated daily calorie intake

Under 1,500

1,500–2,000

2,000–2,500

2,500–3,000

3,000+

No idea

Macro Awareness

Estimated daily protein intake

Target: ~1g per lb of goal body weight. Protein is the #1 lever for body recomposition.

Under 100g

100–130g

130–160g

160g+

Unsure

Primary carbohydrate sources

Whole grains / rice

Fruit

Vegetables

Bread / pasta

Processed / packaged

Sugar / sweets

Low-carb / keto

Primary fat sources

Avocado / olive oil

Nuts / seeds

Dairy / cheese

Fatty meats

MCT / coconut oil

Processed / fried

Meal Timing & Habits

Meals per day

Meal timing approach

Intermittent Fasting

3 Meals / Day

Frequent Small Meals

No Structure

Intermittent Fasting Protocol

12:12

16:8 (most common)

18:6

20:4

OMAD

First meal of the day typically at

Before 8 AM

8–10 AM

10 AM–Noon

After Noon

Behavioral eating patterns

Honest answers here are gold — these patterns drive 80% of nutrition outcomes.

Emotional eating

Stress eating

Night snacking

Skipping meals

Binge / restrict cycles

Mindless eating

None of the above

Hydration & Stimulants

Daily water intake (oz)

Daily caffeine intake

None

1–2 cups

3–4 cups

5+ cups

Last caffeine of the day

Caffeine has a ~5-hour half-life. Cutoff after 2 PM can disrupt sleep quality significantly.

Before noon

Noon–2 PM

2–4 PM

After 4 PM

No cutoff

Alcohol consumption

Alcohol displaces fat oxidation and disrupts sleep architecture — major body composition variable.

None

Occasional (1–2x/week)

Moderate (3–5x/week)

Daily

Prefer not to say

Dietary restrictions or allergies

Supplementation

Current supplements

Protein powder

Creatine

Multivitamin

Omega-3

Pre-workout

Magnesium

Vitamin D

MCT oil

Collagen

Probiotics

None

Other supplements, wellness products, or functional nutrition (e.g., Melaleuca, Thorne, etc.)

Recovery & Sleep

Recovery is where adaptation happens. Poor sleep and unmanaged stress erase gains — this is non-negotiable in the program.

Sleep

Average hours of sleep per night

Sleep quality

Poor

Fair

Good

Excellent

Typical bedtime

Before 9 PM

9–10 PM

10–11 PM

11 PM–Midnight

After Midnight

CPAP or sleep apnea?

Yes — CPAP user

Diagnosed, untreated

Suspected, undiagnosed

No

Common sleep disruptors

Waking during night

Hard to fall asleep

Racing thoughts

Partner / kids

Stress / anxiety

Late screen time

None — I sleep well

HRV & Biometrics

HRV (Heart Rate Variability) is the gold standard for daily readiness. If you're not tracking it, that's something we can fix.

Do you track HRV?

Yes — regularly

Sometimes

No

Unsure what HRV is

Wearable / tracking device

Garmin

Apple Watch

WHOOP

Oura Ring

Fitbit

Samsung

No wearable

HRV baseline (ms), if known

Your personal average over 60–90 days — more meaningful than single readings.

Resting Heart Rate (bpm), if known

Trends in RHR are a strong indicator of recovery and cardiovascular fitness.

Do you track daily steps?

Yes — automatically (watch/phone)

Manually sometimes

No

Do you track body weight?

Daily

Weekly

Occasionally

Never

Stress & Recovery

Current overall stress level (1–10)

5

1 — Zen10 — Overwhelmed

Primary stress sources

Work / career

Financial

Marriage / relationship

Parenting

Health / injury

Low stress overall

Prefer not to say

Recovery modalities you currently use

Foam rolling / Mobility

Percussion / massage gun

Professional massage

Red light therapy

Cold therapy / ice bath

Cold showers

Sauna

Prayer / Scripture meditation

Breathwork

None currently

Energy levels throughout the day

Consistently high

Good in AM, drops PM

Inconsistent / unpredictable

Generally low

Crashes mid-afternoon

Readiness Assessment

Behavioral readiness before programming. Willpower is a resource; systems are the solution.

How ready are you to make consistent changes right now? (1–10)

7

1 — Just exploring10 — All in

What has prevented you from reaching your goals before?

Time / Schedule

Consistency / Motivation

Injury or pain

Nutrition knowledge

No accountability

Cost / Access

Stress / Life events

Haven't truly started

Core motivation

Health & longevity

Appearance

Athletic performance

Faith & Discipline

Family example

Brotherhood / Accountability

How does your faith intersect with your health goals?

Goals & Timeline

Paint the picture. The more specific you are, the better your roadmap.

Primary goal timeline

4 weeks

8 weeks

3 months

6 months

1 year

What does success look like in your own words?

The ONE thing that would make this a home run?

Anything else Coach Moop should know?

Review & Submit

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