AEA Potential Client Questionnaire

Name

First NameLast Name

Email

example@example.com

Phone Number

Area CodePhone Number

If you live outside of the US, what is your WhatsApp number?

Ex. Argentina: +54 9 XXX XXX XXXX

Gender

Date of Birth

Date

Age

years

Height

ft, in

Current Weight

Lbs

Goal Weight

Lbs

When would you like to achieve your goal weight?

Date

In your opinion, do you view fitness as a chore, a tool or something else?

Other

What is your goal?

Tell me about your goals and why they are import to you. What do you think is preventing you from achieving it.

What does your current workout program include? (Include reps, sets, training split, etc)

What is your eating style?

How many times a day do you eat?

What type of work do you do?

Ex. Office Job, Teacher, Restaurant Worker, Nurse, Pilot

Whats the activity level at your job?

What is your weekly workout activity level?

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

Do you have any limitations to exercising?

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

Please rate your motivation level to do what it takes for reach your goal.

⚠️ ⛔️ Unfortunately, you've selected a motivation level that is below that which we are looking for. For online coaching, we only work with people who are highly motivated and equally dedicated to changing their lives for the better.

An alternative that may prove to be of more benefit to you, is a self-paced workout plan. This plan would be something that you can do on your own time. It will guide you through workouts that have been proven to produce good results but not as good as the results that you would get with online coaching.

Have you trained with a coach before?

If yes, what kind of training did you do?

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

Do you have a gym membership?

If you do not currently have a gym membership, are you willing to get one?

What is the name of the gym?

Ex. Gold's Gym or CrossFit Mayhem

List all equipment available at home.

Ex. Dumbbells, Resistance Bands (10, 20, 30 lbs), Jump Rope, Pull up bar, Treadmill, etc

What are your expectations of me as your Coach?

What is your preferred training method?

Because you selected in-person training, how often would you want to train a week?

Please Choose

What program plan are you interested in? Note: All plans are customized to you and available equipment

How did you hear about Alter Ego Aesthetics?

Friend? What's their name?, App Store, Instagram, FaceBook, Ad