First Lady Fitness

Weight Loss Management Form

Client Intake & Transformation

Welcome, You’ve reached this far. You are worth it. This is where you take your power back!!! Change starts with you.

Every question below is designed to help us understand you fully, serve you intentionally, and guide you toward the right program, tools, and support system for sustainable results.

Please answer honestly. There are no right or wrong answers only clarity.

Important:

1. Personal Information

First Name

Last Name

Date of Birth

Phone/Whatsapp Number

Age

Address

City/Town

2. Body Metrics & Starting Point

Current Weight (lbs / kg)

Current Height (ft / cm)

Goal Weight (lbs / kg)

Waist Measurement (cm / inch)

Hip Measurement (cm / inch)

Chest/Bust Measurement (cm / inch)

Arm Measurement (cm / inch)

Thigh Measurement (cm / inch)

3. Your Primary Goal
What matters most to you right now? (Select all that apply):

4. Current Challenges & Struggles
You are not alone. Let’s identify what’s holding you back. (Select all that apply):

Top 3 struggles affecting your daily life right now:

Struggle # 1

Struggle # 2

Struggle # 3

5. Medical Awareness & Self-Care Check
Your health matters. Awareness is power.

Have you had a medical check-up within the last 12 months?

Are you currently under medical supervision for any condition?

Are you taking any prescribed medication?

If Yes, please specify

Are your menstrual cycles regular?

Have you completed your recommended women’s health screenings (Pap smear, blood work, etc.)?

6. Support System & Environment
Transformation thrives in the right environment.

Are you currently part of a wellness or fitness community?

Would you like to be added to our private accountability and support community?

WhatsApp Facebook Instagram Yes, all options

7. Lifestyle & Readiness
Consistency starts with honesty.

How many days per week can you realistically commit to movement?

How would you describe your current eating habits?

On a scale of 1–10, how ready are you to commit to change? (1 - least likely, 10 - most likely)

8. Self-Esteem & Mindset Check
This journey is mental as much as it is physical.

How would you describe your current self-esteem?

When you look at yourself today, which statement feels closest?

Where do you see yourself one year from now—physically, mentally, and emotionally?

9. Tools for Success
Let’s make sure you’re properly equipped.

Which equipment or features do you currently have?

Would you like assistance sourcing any of these?

10. Nutrition, Supplements & Wellness Support
Food is fuel. Supplements are support—not shortcuts.

Are you currently using any supplements or vitamins?

(Our wellness shop carries a full product line. Guidance is always available.)

11. Level of Support You Desire
Choose the experience that best serves you.

What would you like included with Your Program?

Structured workouts Community accountability Education & motivation Weekend weigh-ins & check-ins

Interested in our VIP Private Support Package? Cost: ($22 USD)

It consits of Daily Accountability Check-In, Personal follow-ups for motivation, habits, and consistency. Daily check-ins covering workouts, nutrition, mindset, and life balance. Includes personalized guidance and direct access. Daily Reminder to stay on point with structure. Weekly call.

12. Fitness Programs
(Please check the program(s) you’re registering for):

Consultation Call ($43 USD) House Call 1 on 1 ($572 USD) Outdoor / Gym Personal Training ($500 USD) Online Personal Training, 1 on 1 ($358 USD) Outdoor Group Training ($58 USD) Online Group Training ( 32 sessions + Recording 6am) ($50 USD) VIP Private Support Package (ADD-ON) ($22 USD) Corporate Training

13. Final Reflection

What made you decide to start now?

What do you need most from us to succeed?

14. Commitment Statement

Terms

By submitting this form, I acknowledge that I am ready to invest in myself, my health, and my growth. I understand that transformation requires consistency, support, and personal responsibility.

Terms and Conditions and Liability Waiver Agreement

I agree to the Terms and Conditions and Liability Waiver (Click to read in a New Window)