Name
*
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
example@example.com
Phone Number
-
Area Code
Phone Number
Age
Height
Metric
Weight
LBS
Goal Weight
Overall health conditions: do you have any health conditions that the coach should be aware of?
*
Do you have any deadlines, time crunches or events that you’d like your coach to be aware of? Any special events you want to get ready for?
*
Do you have any injuries that your coach should be aware of while building your training plan?
*
Do you currently take any medication your coach should be aware about?
*
For your nutrition plan specifically, do you have any allergies, foods to avoid, preferences or special requests that your coach should be aware of?
*
Many people want to lose weight and/or get healthy, but what’s YOUR big powerful reason WHY you want to do this?
*
Do you currently have or do any of the following regularly? (check all that apply)
*
Sweet tooth
Eating a lot of snacks
Stress eating
Emotional eating
Late night eating/snacking
Not eating all day
Eating out a lot because of not having food prepared
Going to bed late because of electronic devices
None of these
What do you usually struggle with the most for your nutrition?
*
What do you do for work? What are your typical work hours?
*
What are some challenges that your work/job will create for you along this journey? (if any)
*
What parts of your current lifestyle do you feel need to change for you to get to your goals and become the person you want to be?
*
Rate your experience with exercise
Beginner
Intermediate
Advanced
HIIT/ Circuit Training
Endurance Training
Bodybuilding
Cardio (any form)
Open Gym (general lifting)
What equipment do you have access to? (Check all that apply)
*
Free weights (dumbbell/barbells)
Gym machines (Nautilus, Precor, Cybex, etc... )
Cable weights
Resistance bands
Bosu balls
Kettlebells
TRX Suspension Trainer
Stability Ball
Foam Balance Pad
Sliders
None of the Above
On which days are you available to exercise? (check all that apply)
*
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
How frequently do you have time to exercise?
*
1-3 days a week
4-5 days a week
6-7 days a week
Up to Coach to decide
Anything else you'd like your coach to know? Any other notes, comments, questions or concerns?
*
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