10 weeks of coaching - Next step strength

Name*

First NameLast Name
Best Email address*
example@example.com
Date of Birth*

DayMonthYear
Date
Phone Number
Gender*

MaleFemaleN/A
How did you become aware of Next step strength?

InstagramEmailIn personReferralOther
Training History
What is your primary Goal

Get bigger / Gain muscleGet shredded / Fat lossBody recomposition / a bit of bothStrength / Sport specificAll of the above (greedy)Unsure
Any other information to develop a better training plan for you (sports, goals, intentions)
Working towards goals or constraints around training
How long have you been lifting weights?
If applicable - How long have you been focused on your chosen sport (Powerlifting, Olympic Weightlifting Crossfit)
Bodyweight (in kg)
Height (in cm)
What sort of training have you done in the past?
Programs you have tried, styles of training and things you have struggled with in the past

What is your schedule like and how days are you planning on training and when

	Mon	Tue	Wed	Thu	Fri	Sat	Sun
Morning
Afternoon
Night

Any other details about scheduling (length of sessions, if there is differences in sessions, any major interferences)
Shift worker, on call work, remote work etc
If you have been coached in the past, what you liked and disliked about that experience?
What best describes your equipment availability

Powerlifting gym (plenty of barbells and weights, select machines)Crossfit gym (bumper plates and weights, limited machines)Commercial gym (plenty of weights and machines)Other
If other detail what you have available
Any additional information you feel that would be helpful to know going forward
Adult Pre-Exercise Screening

Physical Activity Readiness Questionnaire
The health benefits of regular physical activity are clear; more people should engage in physical activity every day of the week. Participating in physical activity is very safe for MOST people. This questionnaire will tell you whether it is necessary for you to seek further advice from your doctor OR qualified exercise professional before becoming more physically active.
1. Has your doctor ever said that you have a heart condition and that you should only perform physical activity recommended by a doctor?*

YesNo
2. Do you feel pain in your chest at rest, during your daily activities, OR when you perform physical activity?*

YesNo
3. Do you lose your balance because of dizziness or do you ever lose consciousness? (Please answer NO if your dizziness was associated with over-breathing, including vigorous exercise.)*

YesNo
4. Have you ever been diagnosed with another chronic medical condition (other than heart disease or high blood pressure)?*

YesNo
5. Are you currently taking prescribed medication for a chronic medical condition?*

YesNo
6. Do you currently have (or have had within the past 12 months) a bone, joint, or soft tissue (muscle, ligament, or tendon) problem that could be made worse by becoming more physically active?*

YesNo
7. Has your doctor ever said that you should only do medically supervised physical activity or do you know of any other reason why you should not engage in physical activity?*

YesNo
If you have answered “Yes” to one or more of the above questions, Please provide information in the space below. also, we suggest you consult your physician before engaging in physical activity and tell your physician which questions you answered “Yes” to. After a medical evaluation, seek advice from your physician on what type of activity is suitable for your current condition.

In addition, we recommend you delay becoming more active if you are not feeling well because of a temporary illness such as a cold or a fever. If you are or may be pregnant, please talk to your doctor before you start becoming more active.
Additional injury/health information
Signature*

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Training History

Adult Pre-Exercise Screening