New Client Questionnaire
Please select the coach you wish to work with
Please Select
Coach Kyle
Coach Alexis
Please select the Online Coaching service you'd like to apply for
Please Select
Online General Fitness Coaching
Online Contest Prep Coaching
Your name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Date of birth
-
Month
-
Day
Year
Date
Height
Weight
Waist measurement (inches)
Short term fitness goals: What would you like to accomplish within the next 6 months?
Long term fitness goals: What would you like to accomplish within the next few years?
Please rate how important the following fitness goals are to you.
Not Important
A little Important
Somewhat important
Extremely Important
Weight Loss
Muscle Gain
Strength / Performance
Health Improvement
Do you have any food allergies, dietary restrictions or specific preferences?
Detail your current diet:
Any prior experience tracking calories/macronutrients?
Please list current medications or supplements (if any) and include dosage:
Daily caffeine intake
How many alcoholic drinks do you consume per week?
Do you smoke tobacco or use a vaporizer alternative?
Yes
No
How active are you in an average day?
Sedentary (most of the day spent sitting)
Lightly Active (usually spending a large part of your day on your feet)
Moderately Active (a large part of your day spent doing physical labor)
Extremely Active (a large part of your day spent doing physical labor and/or vigorous exercise)
Do you own a fitness tracker? (e.g. Apple Watch, FitBit, etc.)
Any medical conditions or prior injuries that I should know about?
Please outline your training history.
Please list your favorite exercises.
Please list any exercises you want to avoid (either due to preference or prior injury)
How much time can you generally budget to spend in the gym per day?
How many days per week can you realistically commit to going to the gym?
On average, how many hours of sleep do you get per night?
Any problems falling or staying asleep?
On a scale from 1-5, please rate your general stress levels.
Not stressed
1
2
3
4
Very stressed
5
1 is Not stressed, 5 is Very stressed
On a scale from 1-5, please rate your general energy levels.
Low energy
1
2
3
4
High energy
5
1 is Low energy, 5 is High energy
Standard Release Form
BOLD Bodybuilding & Lifestyle coaches are not licensed Dietitians or Medical practitioners. Any recommendations and information shared is not intended to treat or diagnose any illness or disease. Please consult with your physician before beginning any new fitness program. By signing this, you agree and understand that all information shared by Coach Kyle Cortez and Coach Alexis Cortez is advice and is not meant to be followed to treat, diagnose, or cure any illness.
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