CONSULTATION FORM

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My name is EDVANDRO OLIVEIRA JR.

I am a Personal Trainer, Track and Field Coach, and Owner of COACH JUNIOR CONCEPT.

My team of personal trainers and I serve our clients by helping them achieve optimal fitness, health, and performance levels.

To best assist you with achieving your ideal health and fitness goals, I will need
you to share with me some initial information. Please take 5 minutes to provide details
about your health history, fitness training experience, specific needs, and goals.

Thank you in advance for your interest in working with me and my team.

COACH JUNIOR CONCEPT
The best time to be your best is now!
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Let me know your First + Last name?* This field is required.
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Hey {letMe}, nice to meet you! What is your Email?* This field is required.
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What's the best Phone Number to reach you?* This field is required.
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Birthdate?* This field is required.
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I identify my gender as *ie: Female, He/Him/His, Prefer Not to Answer, etc.
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How did you hear about me ?* This field is required.Choose as many as you like.
Personal Referral
Live/Work Locally
Google/Search Engine
Yelp
Thumbtack
'Top Gyms/Trainers in SF' Listing
Other
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If someone referred you, let me know who that awesome person is!I would love to show them my appreciation!
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If you found me online, great! I would love to know which keywords you used to search for us. As a growing business, this will help me market more effectively to my ideal clients.Example: Personal Trainers, Personal Training SF, Best Trainer San Francisco, etc.
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Which days would you prefer to work out with me? (I train clients between 6a-7p Monday through Friday) Saturday on request* This field is required.
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
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What times of day work best for your schedule? The more options, the better it will be to fit in with the coach* This field is required.
6am-7am
7am-8am
8am-9am
9am-10am
10am-11am
11am-12pm
12pm-1pm
1pm-2pm
2pm-3pm
3pm-4pm
4pm-5pm
5pm-6pm
6pm-7pm
7pm-8pm
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How many days per week would you like to work with a trainer?(One, Two, Three, etc)
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Do you have any specific scheduling requests?Example: Workout 1x week with a trainer + be given homework for an additional workout at home. Please feel free to skip if you do not have any specific requests.
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Based on your background with fitness, working out + athletics, rate your experience level.
Beginner
Intermediate
Advanced
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Which training style(s) do you thrive best under?* This field is required.Please select one or two styles.
Supportive
Direct
Energetic
Laid Back
Intellectual
Lifestyle Coach
Accountability Partner
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On a scale of 1-5, how would you rate your current activity level?1 being rarely active + 5 being very active.
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2
3
4
5
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Please select all activities you are currently involved in.* This field is required.
Gym Membership
Virtual Workouts (ie: Peloton, Tonal, etc)
Yoga
In-person Group Fitness Classes
Daily Physical Activities (ie: Bike, Hike, Run, Walk)
Meditation
Other
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On a scale of 1-5, how would you rate your current state of health + wellness?* This field is required.1 being very unhealthy + 5 being very healthy.
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2
3
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5
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Please explain your rating.* This field is required.
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On a scale of 1-5, how would you rate your stress levels (taking into account emotional, physical, chemical well-being)?1 being stress free + 5 being very
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5
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Please explain your rating.* This field is required.
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Please rate your body coordination and movement. 1 = I often feel *unstable *or unsure of trusting my own body 2 = I feel *competent *in my daily movement and activities 3 = I feel *advanced *and confident in my movements for daily activities and sports
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2
3
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Please describe your current eating habits. Example: Daily nutrition, food allergies, Whole30, vegetarian, paleo, etc
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Goal 1:* This field is required.
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Goal 2:
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Goal 3:
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Goal 1:* This field is required.
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Goal 2:
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Goal 3:
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Do you have any pre-existing or current conditions, injuries, irritations or complications?
Neck/Back
Shoulder
Knee
Ankle/Foot
Hand/Wrist
Other
No Current Injuries
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Summary of Injury.
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Date of Injury.
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Please select all Practitioners you are currently working with.
Primary Care Physician
Physical Therapist
Chiropractor
Body Worker
Orthopedist
Other
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Would your specialist be open to knowledge sharing your case history with our practitioner(s) for assistance in designing your program?
YESNO
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Questions or Comments? Optional to share anguished thoughts, barriers that prevent you from achieving an optimal level of health, or strong points where we can work together.
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Address so I can calculate the duration of the detachment
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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MY CALENDAR * This field is required.We will discuss this information over the phone or video during your free consultationwhich you can schedule here.
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Thank you for sharing your information with me. Enter Initials Below
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