Beyond Binary
Performance
beyondbinaryperformance.com | Houston, TX
Strength Beyond Labels. Performance Beyond Limits.
Client Intake
Health History
PAR-Q+ (Optional)
Fitness & Nutrition
Lifestyle & Goals
Self-Assessment
Body Composition
Don't fill this out if you're human:
Complete Before Your First Session
Client
Intake Form
This form helps your coach understand who you are and build a program that actually fits your life.
A. Personal Information
Full Name
Preferred Name / Pronouns
Email Address
Phone Number
City and State
Time Zone
Occupation / Career
Marital / Family Status
B. Background & Context
What motivated you to seek coaching at this time? What is happening in your life right now?
Have you worked with a coach or trainer before? If so, what worked and what did not?
C. Goals and Objectives
What are your top 3 goals for this coaching program?
Be specific. List them in order of priority.
What does success look like for you at the end of this program?
Paint the picture. How do you feel, what are you doing differently?
What is your realistic timeline for achieving your primary goal?
D. Challenges and Obstacles
What specific challenges or obstacles are you currently facing?
What have you already tried? What got in the way?
E. Coaching Preferences
How do you prefer to be held accountable?
How do you prefer to receive feedback?
Direct and to the point
Gentle and encouraging
A mix of both
Open to whatever works best
Is there anything your coach should know about how you work best or what to avoid?
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Confidential: Complete Before Your First Session
Health
History Form
This information is used to personalize your program and ensure your safety. All responses are strictly confidential.
A. General Health
Date of Birth
Height and Weight (approximate)
How would you rate your overall health right now? (1 = Poor, 10 = Excellent)
Poor
Excellent
Do you have any current or past medical diagnoses?
Include hormonal conditions, chronic illness, mental health diagnoses, etc.
Are you currently taking any medications or supplements?
Which of the following have you experienced? (check all that apply)
Thyroid condition
Insulin resistance / pre-diabetes
Anxiety or depression
Disordered eating history
Autoimmune condition
Chronic pain or fatigue
Elevated hematocrit / blood count concerns
Digestive issues
Sleep disorders
Other
Other conditions or anything else relevant to your health history
B. Hormone Therapy & Transition-Related Health
Current status (check all that apply)
Currently on testosterone / HRT
Not currently on hormone therapy
Had top surgery
Had or scheduled bottom surgery
Wear a chest binder during exercise
Still menstruating
Had hematocrit/bloodwork checked in the last 12 months
N/A
If on testosterone, how long have you been on it? If you've had surgery, what and when?
Anything else about your hormone therapy or transition-related health your coach should know?
C. Injuries and Physical Limitations
Do you have any current or past injuries, surgeries, or physical limitations?
Include location, severity, and whether you are currently receiving treatment.
Are there any movements, exercises, or activities you need to avoid or modify?
D. Sleep, Stress and Energy
Average hours of sleep per night
Less than 5 hours
5 to 6 hours
6 to 7 hours
7 to 8 hours
More than 8 hours
Rate your current stress level (1 = Very Low, 10 = Extremely High)
Very Low
Extremely High
Rate your average daily energy level (1 = Exhausted, 10 = High Energy)
Exhausted
High Energy
Describe your typical stress patterns. What drains you? What restores you?
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Optional: Physical Activity Readiness
PAR-Q+
Readiness Screening
This section is optional, but recommended. It helps your coach flag anything that might need a doctor's input before you start training.
Answer honestly. If you answer “Yes” to anything in Section 1 or 2, that doesn't disqualify you, it just means your coach may ask you to check in with a doctor before starting, or will build your program around it.
Section 1: General Health
1. Has your doctor ever said that you have a heart condition or high blood pressure?
Yes
No
2. Do you feel pain in your chest at rest, during daily activities, or when you do physical activity?
Yes
No
3. Do you lose balance because of dizziness, or have you lost consciousness in the past 12 months?
Dizziness during exercise is NOT included here.
Yes
No
4. Have you ever been diagnosed with another chronic medical condition (other than heart disease or high blood pressure)?
Please list conditions in the notes box below.
Yes
No
5. Are you currently taking prescription medication for a chronic medical condition (not including hormone therapy)?
Please list medications in the notes box below.
Yes
No
6. Do you currently have or have you had a bone, joint, or soft-tissue injury that causes pain, swelling, or limits your movement?
Yes
No
7. Has a doctor ever told you that you should only do medically supervised physical activity?
Yes
No
Section 2: Trans Men's Health Specific
8. Are you currently taking testosterone or another form of hormone therapy?
If yes, please note how long in the notes box below.
Yes
No
9. Have you had any bloodwork (e.g., hematocrit/hemoglobin) done in the last 12 months to monitor hormone therapy?
Yes
No
10. Have you had top surgery, bottom surgery, or any other gender-affirming surgical procedure within the last 12 months, or do you have one scheduled?
Please note the procedure and date in the notes box below.
Yes
No
11. Do you currently wear a chest binder during physical activity or exercise?
Yes
No
12. Do you still menstruate, or have you experienced any pelvic pain, cramping, or related symptoms that affect your ability to exercise?
Yes
No
13. Have you been diagnosed with or are you currently being treated for an eating disorder or disordered eating history?
Yes
No
14. Do you experience significant fatigue, mood changes, or energy fluctuations that you associate with hormone therapy or your transition?
Yes
No
Section 3: Lifestyle Readiness
This section doesn't trigger medical clearance, it just helps your coach understand your starting point.
15. Are you currently physically inactive (less than 30 minutes of moderate activity per week)?
Yes
No
16. Do you smoke or have you smoked in the past 6 months?
Yes
No
17. Do you have a sedentary job or spend the majority of your day sitting?
Yes
No
18. Do you regularly experience high levels of stress, anxiety, or burnout that affect your daily functioning?
Yes
No
19. Do you currently have significant disruptions to your sleep (less than 5 hours per night regularly)?
Yes
No
Notes
Additional context for any “Yes” answers above
Include surgery dates, hormone therapy start date, medications, or anything else your coach should know.
I confirm that my answers above are accurate and complete to the best of my knowledge, and I understand this screening does not replace medical advice.
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Confidential: Complete Before Your First Session
Fitness &
Nutrition Assessment
A. Training Background
How long have you been training consistently?
Brand new to training
Less than 6 months
6 months to 1 year
1 to 3 years
3 to 5 years
5 or more years
What types of training have you done? (check all that apply)
Weight training
CrossFit / functional fitness
Running or cardio
Yoga or Pilates
Group fitness classes
Bodybuilding or powerlifting
Sports or athletics
Little to none
Days per week you currently train
Average session length
Describe your current training routine
B. Strength Baselines (leave blank if unknown)
Squat (1RM or working weight)
Deadlift (1RM or working weight)
Bench Press
Overhead Press
Pull-ups (max reps or assisted)
C. Nutrition Habits
How many times per day do you typically eat?
1 to 2
3
4 to 5
6 or more
Varies significantly
How would you describe your current diet?
No specific approach
High protein focus
Low carb or keto
Vegetarian or vegan
Intermittent fasting
Calorie counting / tracking
Intuitive eating
Describe a typical day of eating
Walk through breakfast, lunch, dinner, and any snacks. Be honest, there are no wrong answers.
Rate your overall relationship with food right now (1 = Very Difficult, 10 = Very Positive)
Very Difficult
Very Positive
Do you have any dietary restrictions, allergies, or foods you avoid?
Nutrition challenges (check all that apply)
Eating enough protein
Overeating or emotional eating
Undereating or restriction
Meal prep and planning
Eating out frequently
Energy crashes
Sugar cravings
Late night eating
Inconsistent hunger cues
Average water intake per day
Caffeine: do you drink it? How much?
List any supplements you currently take
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Confidential
Lifestyle &
Stress Assessment
A. Daily Life and Routine
How would you describe your typical daily schedule?
Very structured and predictable
Mostly structured with some variation
Varied but manageable
Chaotic and unpredictable
Walk me through a typical weekday from morning to night
How many hours per week do you spend on work or primary responsibilities?
Less than 20
20 to 30
30 to 40
40 to 50
50 or more
B. Stress and Recovery
What are your primary sources of stress right now? (check all that apply)
Work or career
Finances
Relationships or family
Parenting
Health concerns
Time pressure
Identity or life transitions
Loneliness or isolation
Caregiving responsibilities
Military or service-related
Rate your ability to recover from stress (1 = I struggle to recover, 10 = I recover quickly)
Struggle
Quick
What does stress feel like in your body? How does it typically show up for you?
What helps you recover, decompress, or regulate? What restores you?
C. Mindset and Motivation
Rate your current readiness for change (1 = Not ready, 10 = Fully committed)
Not ready
Fully committed
What would make the biggest difference in your life right now if it changed?
What tends to get in the way of you following through on commitments to yourself?
What does showing up for yourself look like? How do you know when you are doing well?
D. Values and Identity
What are your top 3 personal values? What matters most to you in life?
How would you describe yourself to someone who has never met you?
What do you want people to say about you? Who are you becoming?
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Understanding Where You Are
Self-
Assessment
Rate your current level of satisfaction in each area of life on a scale of 1 to 10.
Wheel of Life Assessment
Strengths, Patterns and Mindset
What are your 3 greatest personal strengths?
What recurring patterns or behaviors tend to hold you back?
What energizes you? What drains you?
What are your core values? What do you refuse to compromise on?
Rate your readiness to commit to change right now (1 = Not ready, 10 = Fully committed and all in)
Not ready
All in
Explain your rating. What is driving it? What could shift it higher?
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Baseline Tracking Sheet
Body Composition &
Measurements
Measurements are a tool, not a verdict. Track trends over time, not day-to-day fluctuations.
Session Info
Client Name
Date
Program Month
Measured By
Biometrics
Weight (lbs / kg)
Body Fat % (if tested)
Height (inches / cm)
Resting Heart Rate (bpm)
Circumference Measurements (inches or cm)
Neck
Chest
Upper Arm (R), flexed
Upper Arm (L), flexed
Waist
Navel
Hips
Upper Thigh (R)
Upper Thigh (L)
Calf (R)
Calf (L)
Notes
Notes (how you are feeling, recent context, anything relevant)
Submit & Download
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