Body By Tamika logo
Health & Fitness Intake

Tell us about you.
We'll build your plan.

Please complete this form so we can create a fitness and nutrition plan that's safe and tailored to you. All information is kept private and confidential.

Personalized training & nutrition programming
Built around your goals, lifestyle & medical needs
Takes about 5 minutes
Start your questionnaire
Black American woman training with a kettlebell in a bright gym

Please complete this form so we can create a fitness and nutrition plan that's safe and tailored to you.

All information is kept private and confidential.

1

Contact Information

2

Body Measurements

Example: 5'6"

Leave blank if you don't know.

Leave blank if you don't know. We will calculate it for you.

3

Fitness Profile

4

Nutrition Profile

List any food allergies, or type "None".

5

Medical Information

List any medications you take, or type "None".

List any injuries, heart conditions, joint problems or other health conditions, or type "None".

6

Health Vitals

Resting heart rate in beats per minute, if known. Example: 72

If known. Example: 120/80

7

Consent

Your information is kept private and confidential.