Fitbliss Fitness Coaching Application - Lifestyle (training and nutrition)

General Information
Full Name:
First Name*
Last Name*
Age:*
Date of Birth:*
Email:*
Phone Number:*
Mailing Address:*
Height:*
Weight:*
How did you hear about our program?
What is your availability M-F and on the weekends for a 30-60 minute phone consultation?*
In person consultations are available in some areas of Arizona and Utah.
Do you have any trips/vacations coming up in the next 3 weeks? If yes, how many days and do you intend to start after or before your trip?
What time zone are you in?
To help us schedule your consultation.
Current Measurements
Use a cloth measuring tape to take these measurements. (link here)

Here are video instructions on how to take your own measurement. (link here)
Waist (at belly button):
Waist (at smallest part of your waist):
Hips (around largest part of your butt with feet shoulder width apart standing up straight):
Back (at bra line):
Right Arm (flexed):
Left Arm (flexed):
Right Leg: (6 inches above your knee):
Left Leg: (6 inches above your knee):
What's your Why?
What has motivated you to reach out to work with a coach? Why NOW?*
Lifestyle
What do you do for work? Would you consider your daily work stressful?*
Please explain a typical day for you DURING THE WEEK in regards to your nutrition*
Please explain a typical day for you ON THE WEEKEND in regards to your nutrition*
Training History
Have you ever hired a personal trainer, nutritionist or coach? If yes, why did or didn't it work?*
Did you play in sports in high school or college. If yes which sports and for how long?*
Please tell me about a time in your life when you felt the healthiest:*
What are your biggest struggles or weaknesses when it comes to health and fitness?*
What are your top 5 goals?

(in relation to health, performance, lifestyle, mindset and/or body composition)
Goal 1:*
Goal 2:*
Goal 3:*
Goal 4:*
Goal 5:*
Fitness Specifics
Are you currently participating in a fitness program? If yes, what do you do? How long have you been following this program? What do you like and dislike about it?*
Do you currently lift weights consistently? If yes, for how long have you lifted consistently?*
Do you currently do cardio? If yes, what types and for how many minutes each week?*
Where do you workout?
If you workout at home, what equipment do you have access to?

Dumbbells 5-15Dumbbells 20-50Kettlebell 25, 30 or 35Kettlebell 40, 45 or 50Kettlebell 55+Barbell + PlatesLoop BandsHandle BandsPullup BarSquat RackBenchAb RollerSlidersTreadmillBikeRower
Can you Bench press? If yes, how much and for how many reps?
Can you Squat? If yes, how much and for how many reps?
Can you Deadlift? If yes, how much and for how many reps?
Can you do a pull up? If yes, how many?
How long would it take you to walk/jog/run a mile if you were trying your hardest?*
Does your back hurt after you lift weights?*
Nutrition Specifics
Do your currently or have you ever tracked your food in an app like MyFitness Pal*
If yes, do you know how many calories and grams of protein, carbs and fats you get on an average day?*
Have you ever weighed out your food on a food scale?*
How many snacks do you have per day?*
How many meals do you have per day?*
Do you use a protein powder? Why or why not? If yes, do you like your current protein powder?*
How much water do you drink each day?*
How many caffeinated beverages do you have each day? What kinds?*
Health Specifics
Have you seen a general health practitioner within the last year?*
Have you had blood work done to check your vitamin, hormone and thyroid levels in the last year? If yes, what were your results and if any were irregular, what have you been doing to treat them?*
Are you on birth control? If yes, what kind, how long have you been on it and what symptoms do you experience while taking it?*
If yes, have you ever considered coming off of birth control?
Have you ever struggled with an eating disorder or disordered eating? If yes, please share your experience and last incident: *
Have you ever struggled with binge eating? If yes, describe what a binge may look like for you?*
Do you smoke cigarrettes? If yes, how many per day?*
Do you drink alcohol? If yes, how often and how much?*
Are you currently taking any medications? If yes, please list them here:
Are you currently taking any supplements? If yes, please list them here:
Please list any previous or current injuries, physical limitations, aches or pains in detail here:
Have you ever had a baby? If so, have you had any complications postpartum?
Are you currently pregnant or do you plan on becoming pregnant during your program?*
Do you have or wear a step tracker? If so, how many steps per day do you average?
Do you have or wear a sleep tracker? If so, how many hours per sleep do you average per night?
Current Pictures
Some people prefer to take their own photos instead of having to rely on someone else.

Simply set a camera up on a table or chair at about thigh height. You can record a video of yourself facing to the front, side and back then screenshot the video to create your starting photos!
Front

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Side

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Back

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Coaching Packages
Please select the coaching package and/or package add-ons that you are most interested in. Once your application has been reviewed and accepted, you will be contacted by one of our trainers where you will receive more information.
Choose your coach! If you're not sure, don't worry! We will pick the coach that best suits your needs! NOTE: Some coaches may have limited availability
In-Person Coaching Packages:
Online Coaching Packages:
Coupon Code:
Online Training Contract
Data Tracking Compliance

Changing the composition of the human body is a simple, yet time-consuming process. At Fitbliss, we use a data-driven approach to achieve any and all fitness goals. We require clients to track macronutrient intake on MyFitnessPal (or food tracking App of their choice) every day and to also record their daily macro intake, weight, and energy levels on our Fitbliss Log Excel Sheet. Clients may fill out their Fitbliss Log Sheet weekly or daily, but logs must be turned in weekly on the client’s specified check-in day.

From this data, we will determine what changes need to be made and answer any questions/concerns via weekly feedback, which will also be recorded on the Fitbliss Log Excel Sheet.

Because we are science-based fitness coaches, data is of utmost importance to us. If you cannot or will not provide accurate data to us in the protocol outlined above, we cannot execute our methods and you risk forfeiting your place on our coaching roster.

Compliance with data tracking will require 5-10 minutes per day. If you feel you are too busy or not motivated enough to make this happen at this time, we recommend that you wait until you feel you can be more focused.

Personal Accountability

We will tell you what to do and share our tips, experiences, and feedback to help when we can, but ultimately the execution and success of your program is dependent on your actions. We all have those days where we need a little extra encouragement or support and for this purpose, we have created the official Fitbliss Fitness Facebook support group. In general, though, we expect you to be in charge of your own progress by holding yourself accountable and doing your part. As they say, you can lead a horse to water, but you cannot force it to drink!

Check-In Layout + Deadline

You will be given a set check-in day and time. You are expected to meet this deadline each week and to be thorough and open with the information that you provide. Late check-ins will not receive feedback!

Communication

Weekly check-ins are your designated time to ask questions, share your feelings, and/or to tell us things we could be doing to better help you! We aim to support our clients as much as we possibly can, but if you don’t tell us something is wrong we will have no way of knowing. It is your responsibility as a client to be 100% open, honest, and communicative with your coach during your weekly check-ins.

Response Time

We guarantee response time to check-ins within 36 hours, though response time is generally sooner. If for some reason you will not be hearing from us within that 36-hour window, we will give you notice before the end of those 36 hours.

Copyright

All meal plans, training routines, and program info are confidential between clients and their coach. They are fully personalized for each individual and potentially dangerous when used by the wrong person. Plus, sharing your program with someone is wrong. It’s stealing our intellectual property. By signing this contract you agree NOT to share your programming content and acknowledge that if you do, you are at risk for immediate legal action.

Social Media

We LOVE to have our clients share their fitness journey on social media and love even more to be a part of it! Tagging #teamfitbliss or #fitblissfitness is greatly encouraged. However, by signing this contract you agree not to use these tags with posts that contain: full nudity of any kind, illicit drug references, eating disorder references (for example, chewing up food and spitting it out) and/or any type of social media bullying or other distasteful negativity.

Refund Policy

Due to the nature of our personalized programming, refunds are not available.

By signing below I agree to all terms outlined above:
Signature
As the applicant/customer (as stated above), I understand and state: Fitbliss Fitness, LLC "Fitbliss Fitness" (www.fitblissfitness.com) is not a licensed dietitian or medical nutritional specialist. All information I obtain will be directly from Fitbliss Fitness' own experiences. It is of best interest for anyone looking to start a contest preparation/fitness program to consult a physician before doing so; it would be wise to have blood work done, and a physical performed by a licensed physician.

Before submitting this application, please read and understand the following:

I (applicant/customer) totally understand that I (applicant/customer) may injure myself as a result of participation in a contest preparation/fitness program, and hereby release Fitbliss Fitness, www.fitblissfitness.com, and affiliated trainers from any liability now or in the future for any injury, including, but not limited to heart attacks, death, muscle strains, pulls or tears, broken bones, shin splints, heat prostration, knee/lower back/foot injuries and any other illness, soreness or injury however caused, occurring during or after my participation in the bodybuilding contest preparation/fitness program offered.

By submitting this application, I state that in consideration of my participation in Team Fitbliss (www.fitblissfitness.com) contest preparation/fitness program, I for myself, my personal representatives, administrators, heirs and assigns, hereby holds harmless, Fitbliss Fitness (www.fitblissfitness.com), and all affiliated trainers from any claims arising from my participation in the contest preparation/fitness program.

By submitting this application, you affirm that you have read, have been honest with Fitbliss Fitness (www.fitblissfitness.com), and affiliated trainers and also fully understand the above information. You have been given the opportunity to present questions in all related matters.
Do you agree to the "Terms & Conditions" above?*
Should be Empty:

General Information

Current Measurements

What's your Why?

Lifestyle

Training History

What are your top 5 goals?

Fitness Specifics

Nutrition Specifics

Health Specifics

Current Pictures

Coaching Packages

Online Training Contract