Leia Nicole Fitness
Client Application
Submission Date
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Name
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First Name
Last Name
Birth Date
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Month
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Address
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Street Address
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City
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Phone Number
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Format: (000) 000-0000.
Email
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Instagram Handle (if applicable)
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Age/Height/Weight
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How many calories are you currently eating a day? Please include also how many grams of carbs/fats/protein you’re getting. If you are not sure, are you willing to track your food in My Fitness Pal for a week before we start a program?
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What TYPES of foods do you usually eat every day (what does a typical day look like)
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Have you been gaining, maintaining or losing weight over the last 3-6 months?
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What have you been doing for cardio exercise the past 6 months? Please be specific(how many days a week, how long are your sessions, are you doing HIIT or walking or running, etc)
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What supplements are you currently taking?
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Are you taking any medications or under the care of a physician for anything? If so, please describe:
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What areas of your body/trouble spots do you want to focus on?
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What do you like/enjoy about exercise, and what do you dislike?
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How active are you outside of the gym? (are you highly active, are you in any sports, do you have a sedentary job, etc) What do you do for a living?
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When was the last time you stuck to a diet? Did you see results? If no, why do you think that is?
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Have you ever done a fitness program before? (like a weekly class, go to the gym, see a trainer, or use workout DVDs like P90x, etc) if so, what did you do and for how long?
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Have you ever seen results from a workout program? If no, why do you think you didn’t see or maintain those results?
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What do you feel you struggle with when it comes to diet and exercise? (can't find the motivation, it's too hard, don't know where to start, struggle with emotional eating/forgetting to eat, etc)
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Do you ever have any chest pain, trouble breathing, knee pain, joint or muscle pain?
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What are your short term goals?
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What are your long term goals?
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Do you have a history of eating disorders or restrictive eating?
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How would you rate your overall digestion? Please list any current or past issues.
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Do you understand that everyone's body is different, and it may take some time and patience to start seeing results?
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Are you usually hungry between meals?
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How many alcoholic drinks do you have a week? Do you smoke?
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How comfortable do you feel performing strength training exercises with weights?(be specific with how much experience you have, how heavy you have lifted in the past, etc)
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How comfortable do you feel with HIIT (high intensity interval training) and cardio type exercises?
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Please list and describe any injuries or things I need to be aware of when I am designing your program.
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Would you like workouts for at home, at the gym or both? If at home, please also list what equipment you have available to you.
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Please list how many days you will REALISTICALLY workout a week (not how many days you wish you could workout) and the amount of time you can dedicate to each session.
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What is your reason, your WHY for wanting to start a fitness program? What kind of results would you like to see? (example: fat loss, tighten and tone, become healthier overall, learn how to maintain a healthy weight, increase confidence and motivation, build lean muscle, have more energy, establish good habits, etc)
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Are you ready to commit to keeping a food log, making lifestyle changes, and being consistent with checking in with your coach weekly? Rate your readiness on a scale of 1-10, with 10 being “HECK YEAH I AM 100% COMMITTED, FAILURE IS NOT AN OPTION” and 1 being “I AM PROBABLY NOT READY AT ALL AND NOT EVEN SURE WHY I AM DOING THIS”.
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What is your timeline for achieving your goal? (12 weeks, 16 weeks, 24 weeks, 32 weeks, 40 weeks, 1 year)
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What are your expectations of ME as your personal trainer and coach?
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Which days of the week are the best days for you to workout? And what time... Morning, afternoons or evenings?
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Please upload a couple photos of yourself so that I can get an idea of your body type
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