School of Strength

SCHOOL OF STRENGTH
CLIENT FORM

Ths is your comprehensive client information sheet, in which we will ask you to provide some relevant personal information. The answers to these questions are essential in order to allow us to design an optimized individual fitness program for you. Please answer all questions in the most accurate manner possible while being as concise as possible.
DISCLAIMER
Please recognize the fact that it is your responsibility to work directly with your physician before, during, and after seeking fitness consultation. As such, any information provided is not to be followed without the prior approval of your physician. If you choose to use this information without the prior consent of your physician, you are agreeing to accept full responsibility for your decision.
YOUR DETAILS
Name*

First NameLast Name
Gender
Date of Birth*

MonthDayYear
Date
Next of Kin name and Phone Number
Height*
Weight*
Body Fat Percentage: have this taken before completing the form.
BODY COMPOSITION

Only complete if you feel the need to.
Please provide the following girth measurements in cm:
Neck
Chest
Shoulder
Biceps
Waist
Hips
Thigh
Calf
WHAT ARE YOUR GOALS?

Please indicate what goals are important to you.*

	Not important	Somewhat important	Very important	Extremely important
Increased Strength
Improved Endurance
Increased Muscle Mass
Improved Health
Increased Strength
Fat Loss
Increased Power
Weight Gain
Sport Specific

If you indicated SPORT SPECIFIC, please tell us which sport
Do you have a specific timeline for achieving a specific goal?
Which type of progress is more important to you? (tick one)

Immediate progress that’s less easily maintainedMaintainable progress that may not be as rapid
Please explain your answer
Are you exercising regularly (at least 3 times a week)?

YESNO
If you answered NO skip ahead to the section titled “Not Currently Exercising”
CURRENTLY EXERCISING
How long have you been currently exercising without a break (e.g. injury/holiday)?
Please indicate below which type of exercise you do on which days and for how long (Monday = Day 1) RT=Resistance Training INT=Interval Cardio Bouts LIC= Low Intensity Cardio Bouts SSW=Sport Specific Work
NOT CURRENTLY EXERCISING
Complete this section of you are not exercising regularly (more than 3 times a week)
If you have exercised regularly previously, when was this and how long did it last?
WHAT DOES YOUR MIND SAY?
What do you need to change? Think about this as an external motivator (e.g. wedding coming up, big event) or an internal motivator (need to look after my health so I can grow old gracefully).
Why do you need to change? Is it because something someone has said (external influences) or what you have noticed (Internal Influence)
What motivates you? It can be the smallest thing. It can be the upcoming weekend, or something like an upcoming event. It could also be friends and family.
What makes you happy?
MEDICAL AND HEALTH INFORMATION
Please list any diagnosed health conditions
Please list any medication you are taking
Please list any additional therapies or treatments being undertaken for past or previous injuries or health issues
LIFESTYLE INFORMATION
If you are employed, what do you do for a living?
Does you job involve shift work?

YESNo
What is the physical activity of your job?

None (seated work)ModerateHigh
Are you the primary care giver for a child, individuals with a disability, elderly or relative?

YESNO
Do you work Day or Nights?

DAYSNIGHTS
Please list the physical activities you partake in outside of work or the gym?
What is your weekly grocery budget?
How often do you shop for groceries each week?
How often per week do you eat takeaway/at a restaurant?
Please list any known food allergies
Are there any foods you are particularly sensitive to (e.g. bloating, indigestion, congestion)?
Please list any nutritional supplements (and quantities) you are taking?
Please attached a 3 day dietary record. Be sure that this record is representative of the last 3 months’ intake. In other words, if you decided to change your diet in the last 2 weeks, please indicate on the attached record how you would have been eating in the past.
How long have you been eating in the manner recorded on your dietary record?
Do you have Ambulance Cover?

YESNO
OTHER INFORMATION
Do you have any negatives about exercise ? This could be certain exercises, previous training experiences.
What are your triggers when it comes to eating, and if so, how do you control them? We all have triggers, but it’s how we can control them. This question can help us provide information about better eating strategies, and ways to cope to with stress.
Please share your most frequent health, nutrition or physique complaints and/or dissatisfaction with us
Is there any other information you think might be relevant to your program design?
Thank you for taking the time to fill in this information.
Should be Empty:

CLIENT FORM

DISCLAIMER

YOUR DETAILS

BODY COMPOSITION

WHAT ARE YOUR GOALS?

CURRENTLY EXERCISING

NOT CURRENTLY EXERCISING

WHAT DOES YOUR MIND SAY?

MEDICAL AND HEALTH INFORMATION

LIFESTYLE INFORMATION

OTHER INFORMATION