Online Coaching Consultation Questionnaire

CLIENT CONSULTATION:

Strength Starts Within.
This is my online coaching consultation form.

Wondering why I need this info? Well, we are all so different so your program and plan of action needs to be specific to you and your goals. The more accurate information you share the more I can tailor my coaching to your health and fitness needs. Take some time to sit and think about these answers. Any questions that you don’t find relevant please skip past.
Full Name*

First NameLast Name
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Gender

MaleFemale
Date of Birth*

MonthDayYear
Age
years
Height
cm
Weight
KG
What do you do for a living/ studying?
Whats the activity level at your job?

none(seated only)Moderate (light activity such as walking)High (heavy labor, very active)
Do you follow a regular working schedule, do you work days, afternoon or nights?
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.
What additional therapies are being undertaken for the given health problem(s)?
If you have any injuries, please list them.
Are you experiencing any stresses or motivational problems?

YesNo
Do any diseases run in your family?

YesNo
if yes please list:
Your current diet could be best characterised as:

low-fatlow-carbhigh-proteinVegetarian/VeganNo special diet
If you are looking for nutrition programs or guides please in as much detail as you can describe what you would consume throughout the day (food and liquids). Take your time with this to enable me to understand your eating patterns and food choices. Start from your first meal of the day with a rough time and follow on for a 24 hour period, the more information you provide the more accurate I can assess a plan for moving forward with.
Do you have food allergies or intolerances? Any foods that should not be added to your plan?
What is your ultimate goal right now? blank What is the single biggest reason for not achieving it? answer
Please rate your readiness for change.

12345678910
Which of the following best fit in with your goals?

Improved General HealthIncreased StrengthIncreased Lean Muscle MassFat LossFormation of Healthy Habits

TImeline for achieving your goal.

	8 WKS	16 WKS	24 WKS	32 WKS	40 WKS	1 YEAR
NOW

How often are you willing to train a week to reach your goal?
Are you currently exercising at the moment? If yes how often?

NoOncex2x33+Other
Have you followed a program from an Online Coach before?

YesNo
Do you have any specific likes or dislikes with your training? Eg. Dislike squats, loves cardio.
At what times during the day would you prefer to train?

MorningMid-DayAfternoonEvening
What are your expectations on me as your Online Coach?
Inner strength Package Options

ONLINE 1-1 sessionsGroup classes/Group sessionsONLINE coaching(full package)1-1 Personal Training/ Small groupOther
1.) CANCELLATIONS

Cancellations should be made at least 24 hours in advance of a scheduled session. Sessions cancelled less than 24 hours in advance will be charged in full to the client.

2.) LATE ARRIVALS

Each session shall be 1 hour in length. Sessions will not be extended (unless time is available) due to the lateness of the client or due to interruptions caused by the client.

3.) ALL THE INFORMATION I HAVE GIVEN IS CORRECT

All the information on this form is correct and to the best of my knowledge. I have sought and followed any necessary medical advice. I understand that all the information given will be kept confidential.
I AGREE TO THE ABOVE TERMS & CONDITIONS!*

YesNo
Signature

Clear
Should be Empty:

CLIENT CONSULTATION:

This is my online coaching consultation form.