COMPREHENSIVE CLIENT INFORMATION SHEET
Basic Information (Step 1)
CLIENT NAME:
*
Date of Birth:
*
/
Day
/
Month
Year
2 digit day, 2 digit month, 4 digit year
Day/Month/Year
Age
*
Gender
*
Male
Female
N/A
Other
Current Country:
*
Current City:
*
Email Addresss
*
sauro@example.com
Phone Number
*
-
Country Code
Phone Number
Height
*
Weight
*
Knowing more about you
Training Experience
*
Very Low
Low
Moderate
High
Current Physical Activity
*
Low
Moderate
Active
Very Active
Activity Level at Work
*
None
Low
Moderate
Active
Very Active
Are you Practicing any other Sport
*
Yes
No
Which Sports are you playing?
How do you Rank your physical Endurance/Stamina
*
Bad
Average
Good
Excellent
Provide The following Girth Measuremnents
Chest
Arm
Shoulders
Thigh
Waist
Hip
GOALS (Step 2) "Your Goals are my Goals
Select or Rank Your Specific Goals
*
Build Muscle Mas
Increase Streght
Get Shredded
Increase Power
Improve Endurance
Weight Gain
Fat loss
Improve Athletic Skills
Improve Lifestyle
Improve Health Condition
Other
Do you have any specific Goals?
*
Yes
No
Which are your Specific Goals
Is there any timeline for achieving a Specific goal:
Do you have any Muscle group preference that you want to improve the most?
Training (Step 3) "Let other complain while you train"
Training Questionnaire
When was the last time you workout:
*
Are you Interested in any specific type of training:
*
Describe Last training type you had:
*
When Would you like to start?
*
How Many times would you like to do Workout from home a week
*
0
1
2
3
4
(If you are training at home) what type of gym equipment do you have?
How many times would you like to lift Weights a week
*
1
2
3
4
5
6
How many times would you like to workout Upper Body a week
*
1
2
3
4
How many times would you like to workout a week
*
1
2
3
4
5
6
7
How Many times would you like to workout Lower Body a week
*
1
2
3
4
How Many times would you like to do Cardio a Week
*
1
2
3
4
5
Which is your flexibility Level
*
Low
Moderate
High
Super
Which is your Balance Level
*
Low
Moderate
High
Super
Do you know which is your Squat Rep Max: (OPTIONAL)
Do you know which is your Bench press Rep Max: (OPTIONAL)
Do you know which is your Dead lift Rep Max (OPTIONAL)
Do you know which is your military press Rep Max: (OPTIONAL)
Quick Health Questionnaire (Step 3)
Please check the Box(es) if you have been diagnosed with any of the following:
*
High Blood Pressure
Hypertension
High Cholesterol
Heart Disease
Heart Attack
Hyperlipidema
Stroke
None
Do you have any particular Health Condition:
*
Are you currently taking any Medication:
*
Name the medication you are taking:
Please list any Allergies
*
Have your doctor ever said your blood pressure was too High:
*
Are you in the care of a Physician, Chiropractor, or health Professional:
*
Are you unaccustomed to vigoruous Exercise:
*
Have you recently experienced any chest pain associated with exercise
*
Do you have any Current/Old Injury?
*
Do you Smoke? if you do how many a day
*
Resting Heart Rate (RHR):
*
Do you have any Surgery
*
Please check the Box(es) if you have been diagnosed with any of the following:
Intense occupational and recreational exertion
Sedentary Occupational and recreational exertion
Sedentary Occupational and light recreational exertion
Moderate occupational and recreational exertion
Sedentary Occupational and moderate recreational exertion
Complete lack of exertion
Nutrional (Step 4) Don't eat less, Eat right
Nutrition Questionnaire
Are you on any specific food/diet plan at this time:
Do you take any dietary Supplements? If yes, Please List:
*
Do you Experience any frequent Weight Fluctuations:
Have you experienced frequent weight gain or loss:
*
If you have any known food allergies please list them:
*
How many meals would you like to eat a day:
*
Are you sensitive to any Supplement or product:
*
Are you interested in any nutrition Diet Plan:
*
List if you have any nutritional question or concerns:
How many Beverages do you consume per day that contain Caffeine:
*
How Many sodas do you drink a week:
*
How Much Alcohol do you drink a week:
*
How many snacks do you take a day:
Please verify that you are human
*
Submit
Should be Empty: