New Client Application/Intake Form &#8211; Center Stage Athletics & Team CSFP

New Client Application and Intake Form

Ready to begin your journey with Center Stage Athletics (CSA) & Team CSFP? We take what we do very seriously and only want to work with those who are as equally dedicated to making positive changes in their lives as we are to helping you get there. Our promise to every client we work with is to meet you where you are, and then provide you with the tools and guidance to help you become the best version of yourself. Whether you are interested in physique competition or general health and fitness, our promise remains the same. If you are committed to reaching your goals, we'd love to hear from you!

The purpose of this assessment is to serve as the first step for those considering working with CSA and Team CSFP in ANY capacity, accept posing, including: general health/fitness, life athlete, jumpstart or competition prep. Completing this application in no way obligates or commits you to participate in our program. It is imperative that all potential clients understand that CSA & Team CSFP does not provide quick fix or rapid weight loss programs for short-term goals; including general weight loss or physique competition. Our goal is to provide clients with a sustainable, healthy, and moderately paced program that will not only help them reach their goals, but also ensure that they have the foundation, tools and knowledge necessary to sustain their new lifestyle.

PLEASE BE ADVISED THAT PHOTOS ARE REQUIRED WITH YOUR SUBMISSION BELOW.

Along with this form, all applicants are required to submit FULL BODY photos. Photos should be taken in good lighting and should NOT be selfies. Photos should be taken from the front, side and rear. Photos should be taken with the applicant wearing shorts and sports bra or bathing suit to allow CSA coaches to accurately assess the applicant's physique. Photos should be attached at the end of this form.
Basic Information

Tell us about yourself.
Full Name (First Last) *
Email *
Phone Number *

Area Code Phone Number
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Country *
How did you hear about us? *

Internet search Social media Referral
If you were referred by someone, please enter their name below.
Gender *

Male Female
Please select your interest in working with Center Stage Athletics *

Competition prep General Health, fitness or weight loss Mindset/Empowerment Coaching
Current age *
Birthday *

Month Day Year
Date
Height *
Current weight *
How long have you maintained your current weight? *
What is the heaviest weight you've been as an adult (non-pregnancy)? When was this (approximate year)? *
What is the lightest weight you've been as an adult? When was this (approximate year)? *
Lifestyle Assessment

In this section, please tell us about your past and current lifestyle.
Do you work or go to school? What do you do for a living or what is your area of study? *
How many total hours per week do you work or attend school? *
List your hobbies. How physically active are they? How much time, on average, do you dedicate to them on a weekly basis? *
Do you travel for work or leisure? If so, how often? *
Is your job active or sedentary? Please explain. *
Are you married or have a significant other? If so, how supportive are they of your goals? *
Do you have kids? If so, list number of children and ages. *
Health Assessment

In this section, please tell us about your past and current health.
Do you have any past or present injuries, physical disabilities, or doctor recommended restrictions/limitations? *
List all physical and/or medical conditions. *
For example: diabetes, autoimmune disorders, arthritis, hypothyroidism, heart conditions, PCOS, and/or any other conditions you may have. List any doctor's information about your treatment or restrictions either dietary or physical.
Are you currently under the care of a physician for any ongoing medical issue? *
Is there any family history of any of the above listed illnesses? Even if you don't currently have them, please list family members who do. *
Are you now, or have you ever sought treatment for disordered eating of any kind (bulimia, anorexia, binge eating, etc.)? If yes, please explain. *
List any current or past injuries or surgeries. Please explain in detail. *
List any and all current prescription medications you are taking. *
Are you a current or former smoker? *

Current smoker Former smoker Never smoked Vaper Marijuana Use
Have you ever used performance enhancing drugs (PEDs) such as prescription diuretics, anabolic steroids or growth hormone, etc.? If so, when did you last use? *
Have you taken any fat burners in the past 6-12 months? If so, please name them, as well as the time and duration they were utilized. *
In the last month, how much sleep have you averaged per night? *
On a scale of 1-10, how would you rate your stress level on a daily basis? 1 being lowest and 10 being highest. *
WOMEN: Are you peri or post-menopausal?

YES NO
WOMEN: Are you currently pregnant or have you had a child in the last 6 months?

YES NO
WOMEN: Are you currently breastfeeding?

YES NO
WOMEN: Are you and your spouse/significant other currently trying or expecting to try to get pregnant in the next 12 months?

YES NO
Nutrition Assessment

In this section, please tell us about your past and current nutritional habits.
Would you describe yourself as actively dieting, restricting calories/carbs/fats or attempting to lose weight more often than not in recent months/years? If yes, explain. *
If applicable, how long ago was your last diet? What methods did you use and what were your results? Why didn't it work long-term? *
How often do you eat out or get take out or eat food you do not cook yourself? *
When you eat out, what are your typical go-to restaurants or food choices?
Do you socialize often? If so, are meals eaten out involved? *
Do you consume alcohol? If so, how often? *
Please list all non-prescription supplements you are currently taking, including but not limited to proteins, meal replacements, vitamins, pre-workouts, fat burners, etc *
In the last two weeks, how much water have you consumed, on average, per day? *
What is your current daily caffeine intake? Include coffee, energy drinks, pre-workout supplements, pills, etc. *
Do you have any dietary restrictions? *
Vegetarian, vegan, gluten intolerance, diabetic/pre-diabetic, religious, lactose intolerance, or any other? Please state and give as much background as possible.
Are you currently logging or tracking your calories/meals/food via either an app or another method? *
Describe what your current nutrition is like on a daily basis. Provide any macros, if possible, or outline an average day's eating. Do you include cheat meals? Provide as much detail as possible here.
Fitness Assessment

In this section, please tell us about your past and current training and cardio routines.
How many years (if any) have you been consistently weight lifting? *
Please explain your consistency (i.e. I've been training 5 days per week for 5 years). Also, please explain the type of training program you have been utilizing; including no. of exercises, sets, reps, etc. You can attach your current training program below if applicable.
Attach training program here if applicable.

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In the past month, how much cardio have you been performing weekly? Include number of days per week, duration and intensity. *
For example, 3 - 15 minute jogging sessions, 1 bootcamp class of 1 hour.
On a scale of 1-10 how would you rate your comfort level in the gym? 1 being not comfortable and 10 being expert level. *
Have you worked with a personal trainer or other online coach in the past? If so, why did or didn't it work, or what aspects of the program are you hoping to do differently this time around? *
Does your current schedule and/or workload allow you to commit to 5-6 days per week of weight training and/or cardio? If not, please explain. *
Commitment and Goals Assessment

The following are the MOST important questions you will answer. Please give full, detailed answers, not just a yes or no. We only work with those ready and willing to commit to their goals, so please use this as an opportunity to tell us why you are an ideal candidate.
What is your goal in working with our team? Please describe in detail. *
What is your WHY for the goal you have indicated above. What are the most motivating factors for you to increase your level fitness and improve your physique (general fitness or competition related)? Please explain. *
Where there is a strong WHY you will need no HOW.
What do you anticipate could be the most likely factors to discourage or tempt you to stray from your plan or deviate from your goals in any way? *
What does your ideal physique look like? Feel free to attach pictures or links to pictures. *
Attach photos of your ideal physique if applicable.

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Do you consider yourself coachable? Please explain in detail. *
Coachability, n. – the willingness to accept correction and the willingness to act on that correction in order to improve
The trainer-client relationship should be mutually beneficial, and the best way to go about this is by having 100% honest and open communication. Are you willing to commit to this change long-term, keep an ongoing and honest dialogue with your coach, and follow the programs and tools made available to you? *
Do you have any additional information you'd like to share with us or questions you'd like to ask? Please do so here. *
Current Photos

Along with this form, all applicants are required to submit FULL BODY photos. Photos should be taken in good lighting and should NOT be selfies. Photos should be taken from the front, side and rear. Photos should be taken with the applicant wearing shorts and sports bra or bathing suit to allow CSA coaches to accurately assess the applicant's physique. Photos should be attached at the end of this form.
Attach current photos here. *

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Competition Prep Application Clients Only

If you are submitting an application to work with us for competition prep, please complete the section below.
What division(s) would you like to compete in or have you competed in previously?

Bikini Figure Women's Physique Men's Physique Men's Classic Physique Men's Bodybuilding
Please list your previous shows, including date, federation, division, placings and weight at each show.
Attach previous competition photos if applicable.

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What is the next show(s) you are looking to compete in? Do you need assistance choosing shows?
In past competition preps, what is the lowest your calories/macros have gone?
What diet and training methods have you utilized for past competitions?
Attach previous training programs or meal plans if applicable.

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What peaking methods have you used in the past?
In past competition preps, what was the highest amount of cardio you performed per week?
Application Submission Disclaimer

Sign and submit below.
By submitting this application, you agree with the following: I promise that I am providing an honest, comprehensive and complete history of all pertinent health, supplement and dietary information. I understand that not disclosing relevant information could lead to less optimal results and further risk my own health. Please also understand that Center Stage Athletics, LLC (Team CSFP) and its coaches are not a licensed dietitians. I (applicant) fully understand that Center Stage Athletics, LLC (Team CSFP) is a health and fitness consulting firm, not a registered dietician or medical advisor in any way. All recommendations given are undertaken at my own risk. All information I obtain will be directly from Center Stage Athletics, LLC (Team CSFP) own education and experiences. It is of best interest for anyone looking to start a fitness program or bodybuilding contest preparation program to consult a physician before doing so, including a comprehensive physical performed by a licensed physician. I (applicant) fully understand that I (applicant) may injure yourself as a result of participation in any fitness program, and hereby release Center Stage Athletics, LLC (Team CSFP), and any of its coaches, from any and all 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 Center Stage Athletics, LLC (Team CSFP) programs, I for myself, my personal representatives, administrators, heirs and assigns, hereby holds harmless, Center Stage Athletics, LLC (Team CSFP) and its coaches from any claims arising from my participation in the bodybuilding contest preparation/fitness program.By submitting this application, I affirm that I have read, have been honest with Center Stage Athletics, LLC (Team CSFP) coaches and also fully understand the above information.
I agree to above disclaimer. Signature *

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Please verify that you are human *
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Basic Information

Lifestyle Assessment

Health Assessment

Nutrition Assessment

Fitness Assessment

Commitment and Goals Assessment

Current Photos

Competition Prep Application Clients Only

Application Submission Disclaimer