The Upper Notch

Consultation Needs Analysis App

A clean client intake experience for capturing goals, weekly realities, training history, and pre-exercise screening in one place.

Live consultation readyPrint or PDF friendlySave online ready

Assessment Section

Client Details

Capture the basics first so the rest of the conversation stays grounded in the client's actual life context.

Full NameDate of BirthAgeGenderPhone NumberEmail AddressEmergency Contact NameEmergency Contact NumberOccupationReferred ByDate

Work Schedule / Physical DemandsAnything Else To Consider (Non-Medical)

Assessment Section

Goals

This section helps translate a vague desire into a specific coaching target with emotional meaning and practical expectations.

WhatWhere (specific area/focus)Why does this matter?When (timeframe)How will you feel when achieved?How will you feel if not achieved?

What needs to change?What do you need from me / the plan?Commitment level (1-10)Why that score?Past habits that led here

Closer ToHow long have you wanted to start?Set budget

What's been stopping you?

Coaching Lens

Use this section to listen for mismatch between the stated goal, current routine, and real barriers. Those gaps usually shape the best first-phase plan.

Assessment Section

Planning For Success

Build the week with the client instead of around them. This makes adherence more realistic from day one.

Days per week availablePreferred training time

Preferred time quick select

Day

Commitments

Training Time

Notes

Mon

Tue

Wed

Thu

Fri

Sat

Sun

Assessment Section

Training Background

Past experience and preference tell us how to build a program the client will actually enjoy and stick with.

Worked with a coach before

Open to group training

Preferred session duration

Current training / activity levelOther activity stylesWhat did you like?What didn't you like?Favourite training styles / exercisesWhy those?Least favourite / avoidWhy those?

Ideal session / program (2-3 things)

Assessment Section

Health Screening

Pre-exercise screening and health context help us coach responsibly and flag when medical clearance is needed.

Medical Clearance Status

No stage 1 clearance flags selected.

Heart condition / stroke

Chest pain (rest or exercise)

Dizziness / fainting

Asthma attack (last 12 months)

Blood sugar control issues

Other conditions affecting exercise

Injuries / conditions / medical historyFamily history of heart disease

AgeGender

Smoking status

If yes, amount

Weight (kg)Height (cm)BMIWaist circumference (cm)

High blood pressure

Details

High cholesterol

Details

High blood sugar

Details

Taking medications

Medication details

Hospital visits (last 12 months)

Hospital visit details

Pregnancy (if applicable)

Muscle / joint issues

Muscle / joint details

Assessment Section

Client Sign-Off

Capture acknowledgement at the end of the conversation so the notes can move straight into planning.

Full NameSignatureDate

This form stores a local draft in the browser and can now save online as a reusable client record. That gives us the base to connect future forms for the same client in one place.