THE CONFIDENCE COACH : Online Coaching Consultation Questionnaire
Full Name
First Name
Last Name
Age
years
Weight
KG
Instagram handle
Email address
By adding your email you are agreeing to be added onto my email list.
What is your ultimate health and fitness goal right now?
Do you have an end goal/ date in mind?
Please list the physical activities that you participate in outside of the gym and outside of work.:
Have you tried any diets in the past?
If you have any diagnosed health problems list the condition(s).
What is stopping you from reaching your goal right now?
Your current diet could be best characterized as:
low-fat
low-carb
high-protein
Vegetarian/Vegan
No special diet
Please rate your readiness for change.
1
2
3
4
5
6
7
8
9
10
What following goals does best fit in with your goals?
Improved health
Improved endurance
Increased strength
Increased muscle mass
Fat loss
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?
Please rate your motivational level to do what it takes for reach your goal.
1
2
3
4
5
6
7
8
9
10
Are you currently excersising regulary (at least 3x per week)?
Yes
No
Have you trained with a personal trainer/online coach before?
Yes
No
What kind of training did you do?
Whats the best way to contact you?
Instagram
Email
Submit
Should be Empty: