Form WEF-INT-001 · Member Intake

The assessment.

Twelve to fifteen minutes. Submitted to Dana Kantara, MHS (Cellular Health Expert) and Dr. Swet Chaudhari, MD (Chief Medical Officer) for review. They translate what's relevant into a programming brief and pass it to your assigned coach before your first session — so we don't have to ask you twice.

What you write here shapes the first eight weeks of your programming. Be specific. If a question doesn't apply, write n/a. If a question doesn't fit, add the answer in the "additional notes" field at the bottom — they all read margins.

Or download the PDF version →

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Member identification

Full name *

Date of birth

Member ID (if known)

Email *

Phone

Occupation + sit/stand split

Travel cadence

Emergency contact name

Phone

Relationship

Goals

Pick the ones that matter most to you in the next 90 days. The coach uses these as lead variables when there's a tradeoff.

Pain management / corrective Quality sleep + recovery Anti-aging / energy Immune + cellular health Athletic performance Body composition / fat loss Strength + capacity Skin + detox Stress + nervous system

Specific outcome you want in 90 days

Specific outcome you want in 12 months

Training history

Years training consistently

Best modality / sport you've practiced

What worked for you in the past?

What didn't work, and why?

Medical history (relevant only)

We are not asking for full medical records — only what affects load, range of motion, recovery, or programming intensity.

Anything else medical we should know about

Injury inventory

Acute or chronic. Anything that flares with load. Add up to three.

Body part / region

Mechanism / aggravator

Year

Body part / region

Mechanism / aggravator

Year

Body part / region

Mechanism / aggravator

Year

Current medications + supplements

List anything you take regularly (Rx, OTC, supplements)

Lifestyle baseline

No judgment, just data. The coach reads the trend over weeks, not the snapshot.

Sleep quality (typical week)

Stress (typical week)

Energy on a Tuesday afternoon

Joint comfort (typical morning)

Hours of sleep, average

Caffeine, daily

Alcohol, weekly

Tobacco / nicotine

Nutrition baseline

Eating window (e.g., 11am–7pm)

Meals per day

What does a typical breakfast / lunch / dinner look like?

Foods you avoid (preference, allergy, intolerance)

Cadence + access

Days per week available to train

Preferred time blocks

Preferred coach (if any)

1-on-1 vs Team Up vs hybrid

Equipment access at home

Recovery modalities you want to use

Communication preferences

SMS reminders (Atlas) Email follow-ups Phone call before first session None — just the calendar invite The Bioneer publication Member-only protocols + drops

What we should NOT push you on

Anti-pattern: the trainer who keeps suggesting the thing you've already said no to. Tell us what you don't want recommended again.

What success looks like to you, in your own words

Anything else

Additional notes for Dana / Dr. Chaudhari

By submitting, I authorize Wellness Elite Fitness to share this assessment with Dana Kantara, MHS and Dr. Swet Chaudhari, MD for review, and to forward the resulting programming brief to my assigned coach. I understand WEF is a wellness facility, not a medical provider, and any matter outside the scope of fitness coaching will be referred back to my physician. WEF does not diagnose, treat, or prescribe. See privacy policy.