Trans4rm_88 Consultation Questionnaire

Full Name

First NameLast Name

Gender (Biological)

Date of Birth

DayMonthYear

Height

cm

Weight

KG

Phone Number

Please enter a valid phone number.Format: 00000000000.

Email

example@example.com

What do you do for a living?

Whats the activity level at your job?

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.

Are you experiencing any stresses or motivational problems?

Has anyone of your immediate family developed heart disease before the age of 60?

Do you suffer from diabetes, asthma, high or low blood pressure?

Please list:

Are you a current cigarette or vape smoker?

Please rate your readiness for change. (1 Low - 10 High)

Which of the following best describe your goals?

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

Are you currently excersising regulary (at least 3x per week)?

Have you ever used an online coaching program before?

What are your expectations from us as your coaches?

ALL THE INFORMATION I HAVE GIVEN IS CORRECT

All the information on this form is correct and to the best of my knowledge. I have sought and followed any necessary medical advice. I understand that all the information given will be kept confidential.

I AGREE TO THE ABOVE TERMS & CONDITIONS!