Online Coaching Consultation Questionnaire

Online Coaching Consultation Questionnaire

With Latimer Personal Training
Full Name

First NameLast Name
MaleFemale
Date of Birth

MonthDayYear
Age
years
Height
cm
Weight
KG
What do you do for a living?
none(seated only)Moderate (light activity such as walking)High (heavy labor, very active)
Do you follow a regular working schedule, do you work days, afternoon or nights?
RarelyA few times a yearA few times a monthWeekly
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.
What additional therapies are being undertaken for the given health problem(s)?
If you have any injuries, please list them.
What additional therapies are being undertaken for the given injury?
YesNo
YesNo
Please list:
YesNo
low-fatlow-carbhigh-proteinVegetarian/VeganNo special diet
Improved healthImproved enduranceIncreased strengthIncreased muscle massFat loss
What is your goal with your training?
Why?

TImeline for achieving your goal.

Rows	8 WKS	16 WKS	24 WKS	32 WKS	40 WKS	1 YEAR
NOW

How often are you willing to train a week to reach your goal?
12345678910
YesNo
YesNo
What kind of training did you do?
MorningMid-DayAfternoonEvening
What are your expectations on me as your Coach?
3 months coaching - £240 (one off Payment)3 month contract Direct debit - £80 pm1 month coaching - £100Programme with tracker - £35
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.
YesNo
Should be Empty: