New Client Intake — ODINS IRON TEMPLE

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Contact & Basics

Your personal information — kept private, never shared.

Full Name *

Email Address *

Phone Number *

Date of Birth *

Biological Sex * Used by Odin AI to calculate accurate hormone baselines & macros

Gender Identity (optional — helps us personalize your experience)

Emergency Contact Name *

Emergency Contact Phone *

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Health & Safety Screening

Required for your safety. All answers are confidential.

Do you have any current injuries, chronic pain, or movement limitations? *

Yes

Do you have any past injuries or surgeries that still affect how you move, even if healed? *

Yes

Has a doctor ever told you that you have a heart condition, or that you should only exercise under medical supervision? *

Yes

Do you feel chest pain or discomfort during physical activity or at rest? *

Yes

Q10

Do you experience dizziness, loss of balance, or loss of consciousness? *

Yes

Q11

Do you have a bone or joint problem that could worsen with physical activity? *

Yes

Q12

Are you currently taking any medications? *

Yes

Include prescriptions, over-the-counter medications, and supplements. This is used to flag potential food-drug interactions in your nutrition plan.

Q13

Do you have any other diagnosed medical conditions? *

Yes

Q14

Do you have diabetes? *

Yes

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Recent Bloodwork (Optional — skip if unavailable)

If you have recent lab results, these help Odin AI build a more precise nutrition and training plan. All values are private and used only for your programming. Leave blank if you don't have them.

HbA1c (blood sugar %)

Fasting Glucose (mg/dL)

Total Testosterone (ng/dL)

Free Testosterone (pg/mL, optional)

Total LDL (mg/dL)

HDL (mg/dL)

Triglycerides (mg/dL)

Vitamin D (ng/mL)

TSH (thyroid, mIU/L)

Estradiol / E2 (pg/mL, optional)

Lab date (when were these drawn?)

Additional notes (doctor comments, flagged values, etc.)

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Enhanced Athlete Status

Optional & private. This information is only seen by your coach and is never shared. It helps Odin build compound-aware nutrition, training, and supplement protocols.

Do you use or have you used performance-enhancing compounds? (optional)

Yes

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Goals & Logistics

What you're working toward and what you're working with.

Q14

What is your primary fitness goal? *

🔥 Lose Body Fat

💪 Build Muscle

⚖ Body Recomposition

🏋 Strength

⚡ Athletic Performance

🏆 Competition Prep

🩺 Rehabilitation

❤ General Health

Q15

Height & Current Weight *

Goal Weight (optional — what weight are you aiming for?)

lbs

What does success look like to you? (optional — timeline, how you want to feel, what "done" means)

Q15b

Starting Body Measurements (optional — helps track real progress beyond the scale)

Measure first thing in the morning before eating. Use a soft measuring tape, relaxed (not flexed).

Q16

How many days per week can you realistically train? *

Q17

Which training styles interest you? (select all that apply)

Strength Training

Bodybuilding

Powerlifting

Olympic Lifting

HIIT

CrossFit / Functional

Cardio / Endurance

Mobility / Yoga

Group-Style

General / Not Sure

Q17b

What equipment do you have access to? *

🏋 Commercial Gym
Full equipment

🏠 Home Gym
Barbell + rack + DBs

🪙 Dumbbells Only
DBs, bands, bodyweight

🧘 No Equipment
Bodyweight only

Q17c

How long have you been training consistently? *

🌱 Less than 1 year
Beginner

⚡ 1–3 years
Intermediate

🔱 4+ years
Advanced

🔄 Returning after break
Had a gap

Q17d

How long can you realistically train per session?

Q17e

What time of day do you typically train? (helps us time your nutrition correctly)

Q17f

How many hours do you typically sleep per night? (helps us set realistic recovery and training volume)

Q17g

How would you describe your current stress level? (affects recovery, cortisol, and how your plan is paced)

😌 Low
Generally relaxed

😐 Moderate
Normal day-to-day

😠 High
Frequently stressed

😩 Very High
Chronic / overwhelming

Q17h

What's your work schedule like? (helps us plan around shift work, desk jobs, or physical labor)

Q18

Do you have any food allergies or medical dietary restrictions? *

Yes

Q18b

Are there any foods you strongly dislike or won't eat? (optional)

Q18c

Are you currently taking any supplements? (optional)

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Coaching Plan

Choose your tier — all plans are month-to-month, no contracts.

Q19

Which coaching plan are you applying for? *

ᚠ IRON — Build the Foundation $100/mo~$23/week

12-week custom program · Phase adjustments · Weekly check-ins · Supplement recommendations · Pain & injury tracking · Standard 48hr response

ᚱ FORGE — Transform Your Body $200/mo~$46/week

Everything in Iron · Weekly Sunday check-ins · Nutrition coaching · Weekly macro adjustments · Progress photos · Body measurements · Weight trend · Priority 24hr response

★ MOST POPULAR

ᛟ VALHALLA — Elite Coaching $300/mo~$69/week

Everything in Forge · Coaching calls 2–4/month · Form video review · Unlimited modifications · Peak week planning · Same-day response

Not Sure Yet — Let's discuss on the consultation call

Q19b

How did you hear about ODINS IRON TEMPLE? (optional)

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Liability Waiver & Consent

Read carefully before signing.

Q20

LIABILITY WAIVER AND RELEASE OF RESPONSIBILITY

I, the undersigned, acknowledge that I am voluntarily participating in a fitness and nutrition coaching program provided by ODINS IRON TEMPLE, owned and operated by Jonathon Irvine.

Assumption of Risk: I understand that participation in physical exercise and dietary changes involves inherent risks, including but not limited to muscle soreness, injury, or aggravation of pre-existing conditions. I voluntarily assume all risks associated with participation in this program.

Medical Clearance: I confirm that I have answered all health screening questions truthfully and completely. I understand that it is my responsibility to obtain medical clearance from a licensed physician before beginning any exercise program, particularly if I answered "Yes" to any health screening question above.

Nutritional Advice: I understand that nutritional guidance provided by ODINS IRON TEMPLE is not a substitute for advice from a licensed medical professional or registered dietitian. I assume full responsibility for any dietary changes I make.

Release of Liability: In consideration of being allowed to participate in this program, I hereby release, waive, discharge, and covenant not to sue ODINS IRON TEMPLE, Jonathon Irvine, or any affiliated parties from any and all liability, claims, demands, actions, or rights of action, which are related to, arise out of, or are in any way connected with my participation in this coaching program.

Photo/Data Consent: I consent to the use of my progress data (measurements, weight, check-in responses) for the purpose of building and adjusting my coaching program. Progress photos, if submitted, will remain private and will not be shared without my explicit written consent.

Cancellation Policy: All plans are month-to-month. I may cancel at any time with notice before my next billing cycle. No refunds are issued for the current billing period.

By signing below, I confirm that I have read, understood, and agree to all terms of this waiver.

Electronic Signature — Type your full legal name *

Typing your name above constitutes your electronic signature and is legally binding.

Intake Submitted