Online Coaching Form
Please fill out this form so we can have a better understanding of your goals and tailor your programme accordingly
Full Name
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First Name
Last Name
Date Of Birth
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Month
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Day
Year
Date
Phone Number
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E-mail
example@example.com
Weight and Height
Body weight
Height
Body fat % and/or any measurements
If anything, what has stopped you from achieving goals in the past?
What are your goals? What would you like to achieve from Online Coaching?
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Fat loss / ‘Toning’
Gain muscle mass
Improve posture
Increase Strength
Marathon Training
Triathlon Training
Event Training
Functional training
Sports specific training ie for netball, football etc
Pre/Post Natal training
Improve cardiovascular fitness
Powerlifting Competition
Bodybuilding Show Prep
General health and well-being
Other (Please specify...)
You may choose more than one
How many days per week will you be training?
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Make sure this is a realistic number around your lifestyle and work etc
How many minutes do you have to train per session?
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How would you describe your work?
Sedentary
Moderate
Active
Very active
How often would you estimate you reach 10k steps per day?
Never
Not very often
Most of the time
Always
I don’t know
Please state any medical conditions or injuries we may need to know about when designing your exercise programme. Also state any dietary requirements / allergies.
Do you have a gym membership?
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Yes
No
If yes, which gym are you a member of?
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What equipment do you have available at home? (Only applicable if training from home rather than the gym)
What is your preferred training split? Leave blank if unsure
For example Push/Pull/Legs, Upper/Lower, Full Body sessions
What do you feel are your strengths and weaknesses?
For example, if your goals are strength based, perhaps you feel your posterior chain is weaker?
If goals are strength based, state your current 1RM’s or 3RM’s for: Squat, Bench Press, Deadlifts and Military Press
Leave blank if unsure
Exercise Preferences - are there any exercises you really would rather avoid and any you’d love to include?
How would you describe your diet currently?
Healthy
Up and down
Unhealthy
If other, please state
How would you describe your eating habits? Are you following a particular diet? Give as much detail as you like regarding meals, consistency etc
If you’re currently tracking, how many calories are you on per day and what’s your macro split?
Leave blank if you’re not sure what this means or are not currently tracking
How many hours sleep would you say you have on average per night?
Are you happy to receive regular check-ins?
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Yes
No
Are you happy for us to be in touch using the personal details you have provided?
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Yes
No
Add a photograph of your current physique. This is useful to track progress throughout the programme if your goals are aesthetic
Tick if you are happy for us to use your photos or videos for social media marketing
Yes
I understand that the testing undertaken and exercises performed as part of this programme can be physically demanding and that the health screening questionnaire is designed to help me in assessing my fitness for this programme. I will let my Coach know if I have any new medical conditions, injuries or become pregnant. As a condition of my participation I accept full and complete responsibility for my participation in this programme of personal training and, where I have any doubts about my fitness, I have obtained medical approval for my participation. I agree that Emily Killick and Embody Training is/are free of all and any liability for any death, injury, illness or other problems consequent on, or subsequent to, my participation in any training programme or nutrition advice. Please sign below
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