Antabolic Exercise & Nutrition Engineering New Client Application

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Name* This field is required.

First Name

Last Name

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Email* This field is required.

example@example.com

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Address* This field is required.

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

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Phone Number* This field is required.

Please enter a valid phone number.

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Social Media Handles

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Preferred Method of Initial Contact

Text

Email

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Height* This field is required.

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Weight (naked, upon waking, after using the restroom, & before drinking/eating anything)* This field is required.

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Age* This field is required.

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What are your short-term goals?* This field is required.

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What are your long-term goals?* This field is required.

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How important are these goals in relation to other things in your life (education, employment, family, hobbies, social life, etc.)?* This field is required.

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Do you have the support of your family and friends in achieving your fitness goals?* This field is required.

YESNO

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Do you personally foresee any potential obstacles in regard to achieving said goals? If so, please elaborate how & why.* This field is required.

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What time do you wake up & go to bed?* This field is required.

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What is your occupation & work schedule? Do you have an active or more sedentary role?* This field is required.

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Are you in school? If so, for what and when? Do you commute or reside on campus? How much time do you have left?* This field is required.

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How do you spend your time (children/family commitments, hobbies, social life, etc.)?* This field is required.

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How many days per week can you commit to exercise? For how long?* This field is required.

Please enter a number of days (0-7)

Please select from the following

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What time/s of day do you currently/would you be able to exercise?* This field is required.

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Do you drink alcohol &/or use recreational drugs? How much, how often, & what kind/s?* This field is required.

Please select from the following

Please elaborate honestly

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How would you rate your sleep?* This field is required.

Excellent

Good

Fair

Poor

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Do you have difficulty falling asleep?* This field is required.

YESNO

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Do you have difficulty staying asleep?* This field is required.

YESNO

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On average, how many times per night do you wake up? Do you fall back asleep easily?* This field is required.

Please enter a number

Please select from the following

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Do you wake up feeling refreshed?* This field is required.

YESNO

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How would you rate your stress levels on a day-to-day basis?* This field is required.

High

Moderate

Low

None

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Do you have access to a gym/fitness center?* This field is required.

YESNO

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How much experience do you have with weight training? Have you tried programs in the past with positive results?* This field is required.

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What type of cardio, if any, has helped you get the best results in the past?* This field is required.

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How many days are you currently training? Describe your regimen in detail (rep ranges/rest times/split (what muscle groups when)/volume).* This field is required.

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Are you currently doing cardio? If so, please specify exactly how much, what type, when, & level of intensity (estimated heart rate, machine level/setting).* This field is required.

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Do you have any injuries? Are there certain exercises that you avoid/are physically unable to perform? If yes to either, please describe in detail.* This field is required.

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Do you have any health conditions that may impact your ability to exercise &/or adhere to a fitness program? Have you ever been found medically unfit for exercise? If so, please explain in detail.* This field is required.

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Do you have recent labwork results?* This field is required.

YESNO

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Describe in detail, a typical day of eating/drinking. Include any known macronutrient (protein/carbs/fat/calories) breakdown.* This field is required.Please use the following format: Time - Meal 1: Time - Meal 2/Snack: etc. etc.

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How long have you been at this current intake?* This field is required.

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How is your body weight affected by your current intake?* This field is required.It is ...

Constant

Decreasing

Increasing

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List any/all foods you enjoy.* This field is required.Do you have any allergies or food sensitivities? Do you notice a negative response with any particular foods (bloating, gas, pain, tiredness, joint pain)?

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List any/all foods you dislike. Specify any you absolutely can't stand/won't eat.* This field is required.

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Do you have any allergies &/or food sensitivities? Do you notice a negative response after consumption of any particular foods/food groups (gastrointestinal distress, tiredness, joint pain/stiffness, overall inflammation, etc.)?* This field is required.

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Do you have any digestive issues (bloating, gas, stomach discomfort/pain, abnormal bowel movements, etc.)? If yes, have you seen a doctor for this? Please explain in detail.* This field is required.

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How would you rate your current performance in the gym (if applicable)?* This field is required.

Excellent

Good

Fair

Poor

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How would you rate your current day-to-day (natural) energy levels?* This field is required.

Excellent

Good

Fair

Poor

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Do you consume caffeine? If so, from where, how much, & how often?* This field is required.

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Please list any/all nutritional supplements &/or vitamins/minerals you currently consume (specify brands & dosage).* This field is required.

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Are you currently taking any otc &/or prescription medication? If so, please list in detail with dosage & frequency of each.* This field is required.

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Are you currently or have you ever used performance enhancing drugs?* This field is required.

YESNO

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If you answered NO to the previous question, have you considered use of PEDs under proper guidance?

YESNO

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If you answered YES to having used/using PEDs. please list all current &/or recent compounds, dosages, and durations. Explain in honest detail what has given/gives you the best results, any side effects you’ve experienced/are prone to, etc. This applies to AAS, SARMs, Peptides, Ancillaries, etc.

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Are you on currently on birth control? If yes, which type and for how long.

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Are you having a regular menstrual cycle? Please explain any current or past irregularities.

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Please tell me exactly what you would like to get out of my guidance and how to best make your experience a positive one.* This field is required.

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Ready to move forward? Lock in your discovery call and let’s talk next steps!This 15-minute call is designed to determine if we’re the right fit to work together. We’ll go over your goals, current challenges, and what you truly need from a coach — then I’ll outline the most effective path forward. This isn’t a free chat. It’s a focused, high-value conversation for individuals who are serious about investing in themselves and committed to real change. I only work with those ready to show up, do the work, and go all-in on their transformation. Booking Fee: A $50 USD payment is required at the time of booking. This fee is non-refundable, but if you sign up for coaching within 30 days, it will be fully credited toward your plan. If you choose not to move forward with coaching, you’ll receive exclusive Team Antabolic merch (valued at $50 or more) as a token of appreciation for your interest and commitment to taking that first step.

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From where/who did you hear about my services?* This field is required.