Client Questionnaire
Administrative
Full Name
First Name
Last Name
Gender
Male
Female
Age
Years
Height
Feet
Weight
LBS
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Part 2. Lifestyle Information
What do you do for a living?
Do you follow a regular working schedule, do you work days, afternoon or nights?
Please list the physical activities that you participate in outside of the gym and outside of work
How many hours of sleep do you get per night?
4
5
6
7
8
9+
Part 3. Medical and Health Information
If you have any diagnosed health problems list the condition(s).
If you are on any medications, please list them.
If you have any injuries, please list them.
Do you use Tobacco products?
Yes
No
Do you use consume Alcohol?
Yes
No
Are you currently taking any supplements?
Yes
No
If yes, please list them.
Any food allergies?
Yes
No
Foods you do not like, so please list them.
What did you have yesterday to eat, please list all meals.
Part 4. Goals
Which best describes your goals?
Improved health
Improved endurance
Increased strength
Increased muscle mass
Fat loss
What is your short and long term goal with your training?
Do you currently have a gym membership?
Yes
No
How often are you willing to train a week to reach your goal?
Are you currently exercising regularly?
Yes
No
What are your expectations on me as your Coach?
Submit
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