Virtual Coaching w/ Megzilla

1

Full Name* This field is required.

First Name

Last Name

2

Gender

Male

Female

3

Date of Birth* This field is required.

4

Age

years

5

Height

cm

6

Weight

KG

7

What do you do for a living?

8

Whats the activity level at your job?

none(seated only)

Moderate (light activity such as walking)

High (heavy labor, very active)

9

Do you follow a regular working schedule, do you work days, afternoon or nights?

10

How often do you travel?

Rarely

A few times a year

A few times a month

Weekly

11

Please list the physical activities that you participate in outside of the gym and outside of work.:

12

If you have any diagnosed health problems list the condition(s).

13

If you are on any medications, please list them.

14

What additional therapies are being undertaken for the given health problem(s)?

15

If you have any injuries, please list them.

16

What additional therapies are being undertaken for the given injury?

17

Are you experiencing any stresses or motivational problems?

Yes

No

18

Has anyone of your immediate family developed heart disease before the age of 60?

Yes

No

19

Do any diseases run in your family?

Yes

No

20

Do you suffer from diabetes, asthma, high or low blood pressure?

Yes

No

21

if yes please list:

22

Are you a current cigarette smoker?

Yes

No

25

What following goals does best fit in with your goals?

Improved health

Improved endurance

Increased strength

Increased muscle mass

Fat loss

26

What is your goal with your training?

27

Why?

29

How often are you willing to train a week to reach your goal?

31

Are you currently excersising regulary (at least 3x per week)?

Yes

No

32

Have you trained with a personal trainer before?

Yes

No

33

If yes what kind of training did you do:

34

At what times during the day would you prefer to train?

Morning

Mid-Day

Afternoon

Evening

35

How many days do you want to train per week?

Please Choose

36

Do you workout at home or in gym?

37

If at home, what do you have for equipment?

38

What are your expectations on me as your Coach?

39

Tell me your “WHY”

40

Email

example@example.com

41

How did you hear about me?