Email

Occupation

Emergency Contact Name + Number

Goals + Motivation

What are your primary fitness goals? (e.g., fat loss, muscle gain, increased energy, overall health)

What are your top 3 areas of focus you want to work on with Brandon?

How committed are you to making changes right now? (1–10)

Have you ever worked with a personal trainer or coach before? If yes, what worked well / didn’t?

Current Lifestyle + Activity

How many days per week do you currently exercise (if any)?

What types of movement do you enjoy or dislike?

Do you have any current or past injuries or limitations?

How many hours of sleep do you get on average per night?

Nutrition + Habits

On a scale of 1–10, how would you rate your current nutrition?

Any known food allergies, sensitivities, or restrictions?

How many meals do you typically eat per day?

Do you drink alcohol? If yes, how often?

How much water do you drink daily?

Medical History

Are you currently taking any medications or supplements?

Program Logistics

How did you hear about Body Alchemy by Brandon?

Body + Nutrition Coaching by Brandon Rogers

Let’s work together