Full Name
*
First Name
Last Name
Gender
Male
Female
Date of Birth
*
Please select a month
January
February
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Month
Please select a day
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Day
Please select a year
2026
2025
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Year
Age
years
Height
cm
Weight
KG
What do you do for a living?
What's the activity level at your job?
none(seated only)
Moderate (light activity such as walking)
High (heavy labor, very active)
Please list the physical activities that you participate in outside of the gym and outside of work.:
If you have any diagnosed health problems list the condition(s).
If you are on any medications, please list them.
If you have any injuries, please list them.
Are you experiencing any stresses or motivational problems?
Yes
No
Has anyone of your immediate family developed heart disease before the age of 60?
Yes
No
Do any diseases run in your family?
Yes
No
Do you suffer from diabetes, asthma, high or low blood pressure?
Yes
No
if yes please list:
Are you a current cigarette smoker?
Yes
No
Your current diet could be best characterized as:
low-fat
low-carb
high-protein
Vegetarian/Vegan
No special diet
Have you ever tracked your food/macros before?
What following option best fits in with your goals?
Improved health
Improved endurance
Increased strength
Increased muscle mass
Fat loss
Cardiovascular
What is your goal with your training?
How often are you willing to train a week to reach your goal?
Have you trained before?
Yes
No
If yes what kind of training did you do:
What are your expectations on me as your Coach?
What is your Email address?
What is your phone number?
Feel free to add any other comments or questions you may have below!
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