Online Coaching Consultation Form

Online Coaching Consultation Form

Please fill in all the details and I look forward to getting started!
Full Name

First NameLast Name
Gender
Date of Birth

MonthDayYear
Age
years
Height
ft, in
Weight
If unsure give your most accurate guess
Phone Number

Area CodePhone Number
Email
What do you do for a living?
Are you looking to train IN PERSON (Long Beach, CA) or ONLINE?
Whats the activity level at your job?
Do you currently have a gym membership or a home gym?
Please list the physical activities that you participate in outside of the gym and outside of work.:
If you have any diagnosed health problems list the condition(s).
If you are on any medications, please list them.
If you have any injuries, please list them.
Do you suffer from diabetes, asthma, high or low blood pressure?
if yes please list:
Are you a current cigarette smoker?
Please rate your readiness for change.
What is your goal with your training?
Why?
Are you currently excersising?
Have you trained with a personal trainer before?
What are your expectations on me as your Personal Trainer?
Remember to follow my instagram: @Jemillio

Thank you!
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