Personal Information:
Name
First Name
Last Name
Email
example@example.com
Phone Number
-
Area Code
Phone Number
Height (cm's)
Weight (kg's)
Age (years)
Training:
What is your main goal focused around ?
Weight loss
Increasing muscle mass
Body recomposition (reducing body fat while maintaining muscle mass)
Athletic performance
Other
When was the last time you followed a structured training program to achieve your goals?
Have you ever done PTs before and what was overall experience? What is the reason you are moving from your current coach? (for people interested in PTs)
Have you ever followed an online training program ? If yes, please explain for how long and why did you stop ?
Do you have any injuries, list the condition(s).
Do you practice any other activities ?
Yes
No
If yes, what type of activities are these and how many times per week you practice them?
How many steps you conduct per day ?
Nutrition:
Can would you rate your nutrition ?
Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
Are you currently on a specific diet plan ?
Yes
No
How many meals you eat per day?
Are you experiencing any stress or motivational problems?
Yes
No
Do you have any food allergies or intolerances? If yes, list below.
Do you take any supplements or vitamins ?
Yes
No
If yes, list below.
Do you have any diagnosed health problems, list the condition(s).
Do you suffer from any of the below conditions?
Diabetes
Asthma
Low blood pressure
High blood pressure
Non
Plan agreement:
What online coaching package would you be interested in? "note: I offer only 3 months plan as this is the most accurate timeline of when clients will start seeing results" :
3 months online training plan
3 month nutrition plan
3 months online training and nutrition plan
Please select the date you would like to start your package.
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
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