Sweat, Love, & Macros Personal Training and Nutrition Coaching Questionnaire

Personal Training and Nutrition Coaching Questionnaire

Thank you SO MUCH for reaching out to me about your fitness goals! It is SO exciting that you want to take your fitness to the next level and are looking for guidance! Please fill out the following information and be as detailed as possible as it will help me get to know you more and create a program that will best get you to reach your fitness goals!
Basic Information
Name*
Birthday*
Height*
Weight*
Body Fat %*
Email*
Location*
How did you hear about this service?*
Medical History
Have you ever had any pain or injuries (ankle, knee, hip, back, shoulder, etc)?If yes, please explain:*
Have you ever had any surgeries? If yes, please explain:*
Have a medical doctor ever diagnosed you with a chronic disease, such as coronary heart disease, coronary artery disease, hypertension, high cholesterol, or diabetes? If yes, please explain:*
Are you taking any current medication? If yes, please explain:*
Lifestyle
What is your current occupation?*
Does your occupation require extended periods of sitting?*
Do you know on average how many steps you take each day?*
Does your occupation require extended periods of repetitive movements?*
Does your occupation require you to wear shoes with a heel(dress shoes)?*
Does your occupation cause you anxiety or mental stress?*
Do you partake in any recreational activities (golf, tennis, skiing, etc)?*
Do you have any hobbies (reading, gardening, working on cars, etc.)?*
Fitness History
What has been your exercise routine for the past 6 months? If none, then please describe any exercise activity you have done in your life.*
Do you currently enjoy the exercise routine you are doing? What is your favorite thing about it? What results have you seen from it?*
If I told you that there was a more optimal way for you to reach your fitness goals besides what you are currently doing, would you be open to changing your routine?*
Is there anything about your exercise routine that you absolutely love and would not want to give up?*
Have you ever worked with a personal trainer and/or nutrition coach before? If yes, what was your experience?*
Nutrition History
What has been your nutrition been like for the past 6 months? (Ex: followed a low calorie plan for 2 months then started eating whatever for 2 months)*
What results have you seen from following that nutrition routine? Are you happy with the results? *
If you were following a specific diet (ex: paleo, keto, atkins, etc.) Do you think it is a diet that you enjoy and could follow for the rest of your life?*
If I told you there was a more optimal way for you to reach your fitness goals besides what you are currently doing, would you be open to changing your nutrition routine?*
Do you currently, or have you ever, counted calories or macros? *
If yes, what is your current calorie and macro intake? If not, do you know about how many calories you intake in a day?If you do not know your calories then please describe in detail what a typical few days of eating looks like for you. *Please provide a normal day of eating at home or with home prepped food and a day of what you normally get when you eat out.*
How often do you go out to eat?*
About how much water do you drink daily?*
Do you typically drink soda, juice, smoothies, specialty coffees (Lattes or Frappuccino), or energy drinks? What kind?*
Do you drink alcohol? What kind? (Ex: Beer, Wine, Cocktails) About how many drinks do you have a week?*
How would you describe your overall relationship with food? Have you had any issues with overeating or undereating?*
Goals
I have a significant amount of weight to lose (15+ lbs)I am looking to tighten up and maybe lose 5-10 lbsI may not need to lose weight, but know I need to lose body fat.I am not looking to drastically change my body but know I want to feel stronger and more balanced with food. (An option for those looking to learn more about balanced nutrition and also may want to work on Reverse Dieting.
Getting more specific is your #1 fitness goal that you wish to accomplish? Specifically, how do you want to feel and what do you want to look like?*
How long do you realistically think it will take you to reach this goal?*
What do you struggle with in terms of reaching this goal?*
On a scale of 1-10(1 being not important to 10 being extremely important: how important is it for you to overcome your fitness and health obstacles and achieve your goals?*
Are you looking for guidance in training, nutrition, or both?*
If training or both, do you have a gym membership or access to a gym? If working out at home, what a equipment do you have available? How many days a week could you commit to working out?*
If nutrition or both, in order to get results that you can keep, learning how to track macros and embracing balanced nutrition is 100% needed for success. I provide my clients with a lot of tools and support to make this an easy learning transition, but are you willing to embrace learning nutrition basics for lasting fat loss and nutrition balance?*
Are you looking to receive just a Training Program and/or Macro Calculation to execute on your own? Or are you also looking to work with me as your Coach to have weekly check-ins and make program adjustments when needed?*
Are you healthy and capable enough to follow a Personal Training and Nutrition Coaching Program?*
By signing and submitting this document I am certifying that all information provided is true to the best of my knowledge.
Applicant Signature: *
Date:*
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Personal Training and Nutrition Coaching Questionnaire

Basic Information

Medical History

Lifestyle

Fitness History

Nutrition History

Goals