Online Coaching Questionnaire
Citadel Strength Co.
Name
*
First Name
Last Name
Email
*
example@example.com
Birthday
*
-
Month
-
Day
Year
Date
Basic Health
Has your doctor ever told you that you have a heart condition or have you ever suffered a stroke?
*
Yes
No
Do you ever experience unexplained pains in your chest at rest or during physical activity / exercise?
*
Yes
No
Do you ever feel faint or have spells of dizziness during physical activity/exercise that causes you to lose balance?
*
Yes
No
Have you ever had an asthma attack requiring immediate medical attention at any time over the last 12 months?
*
Yes
No
If you have diabetes (type I or type II) have you had trouble controlling your blood glucose in the last 3 months?
*
Yes
No
Do you have a bone, joint or any other health problem that causes you pain or limitations that must be addressed when developing an exercise program (i.e. diabetes, osteoporosis, high blood pressure, high cholesterol, anorexia, bulimia, anaemia, epilepsy, respiratory ailments, back problems, etc.)?
*
Yes
No
Do you have, or have you had any inflammatory conditions such as arthritis, GI upset or discomfort, skin inflammation or psoriasis?
*
Yes
No
Has a doctor ever recommended medication for your blood pressure or heart condition?
*
Yes
No
Do you have any medical conditions, pain or injuries?
*
Yes
No
If you answered YES to one or more of the questions above, please answer the following questions: Have you consulted your doctor regarding increasing physical activity and/or performing a fitness assessment?
Training History
Which service are you interested in?
Online Coaching
Personalised Programming
How long have you been lifting weights?
*
How long have you been powerlifting?
*
What does your current training look like?
*
With your current training, what do you enjoy about it and what do you dislike?
*
Do you have experience using training protocols like RPE or Reps in Reserve?
*
If you have previously had a coach, what have you enjoyed about the relationship and what have you disliked?
*
What has made you want to try online coaching with Citadel Strength Co?
*
Do you have a powerlifting competition planned?
*
Do you train at a gym or at home? What equipment do you have access to?
*
Squat 1 Rep Max
*
Bench 1 Rep Max
*
Deadlift 1 Rep Max
*
What are at least three times that work for you for us to book in an initial chat via zoom?
*
Submit
Should be Empty: