PowerVita

Intake & Registration

Welcome to PowerVita. Please complete this form as fully and honestly as possible. Based on your answers, we will align which trajectory fits you best. All information is treated confidentially and used only for your personal coaching.

1. Personal details

Fill in your basic details so we can contact you and register your trajectory properly.

First name *

Last name *

Date of birth *

Email address *

Phone number *

Address

Postal code

City

2. Type of trajectory

Choose what you are interested in. If you are unsure, choose “advice needed”.

What would you like to sign up for? *

How often would you like to train/receive coaching?

Preferred session duration

Which trajectory length do you prefer? *

When would you like to start?

3. Goal

Here we look not only at what you want to achieve, but also why it matters to you.

What is your main goal? *

Why do you want to achieve this goal?

Why is this important to you?

What would change in your life if you achieved this goal?

How do you currently feel about your body, health and energy?

4. Current situation

Height in cm *

Current weight in kg *

What kind of work do you do?

How would you describe your work?

How much do you move on average per week?

Do you have experience with sports or fitness?

If yes, what have you done?

Are you currently training? If yes, how often?

5. Health

This information is important so we can coach you responsibly.

Do you have injuries, pain complaints or physical limitations? *

Where are these complaints and when do you notice them?

Are you currently receiving treatment?

Do you use medication? *

If yes, which medication do you use?

Are there medical conditions PowerVita should take into account?

Are there any other important things we should know?

6. Nutrition

Would you like nutrition guidance?

Do you use a nutrition app?

Do you have allergies or intolerances?

Are there foods you do not eat?

What does your current eating pattern look like?

What would you like help with regarding nutrition?

7. Expectations and motivation

What are you currently struggling with most?

What do you expect from PowerVita?

Where do you need the most help?

How motivated are you? (1–10)

What do you need to sustain this trajectory?

8. Availability and start

Which days and times usually work well for you?

Any planning notes

9. Terms, privacy and agreement

Important points:
Training sessions must be cancelled at least 24 hours in advance. If you arrive late, the missed time is deducted from the session. PowerVita provides coaching and guidance, but no medical treatment or diagnosis. If a trajectory is ended early, the rate may be recalculated based on the period actually completed. Read the full terms here: PowerVita general terms. Also read the Privacy Policy.

I have read the general terms and agree to them. *

I declare that I have completed this form honestly and fully. *

I understand that PowerVita provides coaching and does not provide medical treatment or diagnosis. *

I am responsible for reporting injuries, complaints and changes in my health. *

I give permission for PowerVita to process my personal data and health-related intake data to assess my request and provide coaching, guidance, administration and app functionality. *

I understand that my data will be treated confidentially and will not be shared with third parties without permission. *

I understand that my registration is only final after confirmation from PowerVita and agreed payment arrangements. *