Physical Fitness Questionnaire

1:1 Coaching Application
Name*

First NameLast Name
Email*
example@example.com
Your Age*
Weight*
Height*
Feet and Inches
What is your user name for MyFitnessPal.com (so I can friend you)?
What is your job?*
Goals (Check all that apply)*

Muscle BuildingWeight Loss and Fat LossStrength BuildingLifestyle ChangeHealthy Food Habits
1. How many hours a day do you sit?*

Less than 2 hours2-3 hours4-5 hours6-7 hoursMore than 7 hours
2. Do you currently do any cardio activities? If so what is the duration of cardio each week:*

1-2 hours3-4 hours5-6 hoursMore than 7 hoursnone
3. Do you regularly have a lifting/strength trainman regimen?*

YesNo
4. Do you regularly have a nutrition regimen?*

YesNo
If "Yes" in a few words please explain your nutrition regimen:
5. Do you have any injuries or health conditions?*

YesNo
If "Yes", please explain your injuries or health conditions:
6.Are you Vegan or Plant based?*

YesNo
7. Please list any supplements that you are currently taking:
8. What is your dieting/coaching history?
9. How often have you dieted for weight or fat loss over the last 5 years?
10. Have you tracked macros or calories before?*

YesNo
11. How much time do you spend walking each day?

Less than 15 minutes15-30 minutes30-60 minutesMore than one hour
Please verify that you are human*
Should be Empty:

1:1 Coaching Application