1:1 Training Intake Form
1:1 Online Personal Training is perfect for those that want to create an intentional strategy to gain strength through fitness goals by creating a sustainable workout routine that doesn't demand hours of time a day! Complete this form so I can determine your blindspots on your health journey and customize a plan for you!
Name
*
First Name
Last Name
Email
*
example@example.com
Today's Date
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-
Month
-
Day
Year
Today's Date
Phone Number
*
Please enter a valid phone number.
Age
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Height
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Current Weight
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Allergies/Food Sensitivities?
*
Describe you overall health & fitness goals and desire for improvement that made you decide to take this next step.
Describe your biggest struggle and victory in your health journey so far.
Describe your current activity level
Sedentary (sit a lot, little movement)
Light activity (exercise 1-3x a week)
Moderately active (exercise 4-5x a week)
Very active (exercise 6-7x a week)
Extremely active (physical job, exercise 5-7x a week)
Describe your activity level. How long have you been active? What activities have you done consistently in the past? What types of activities do you currently do? What time of day do you typically work out (or prefer to)?
Provide any details that can help me understand your current activity level.
Describe your comfort level with weight training
Please Select
Very beginner, never lifted
Beginner, some experience
Intermediate, I've lifted in the past and am comfortable with weights
Advanced, I've lifted for years
Outside of your exercise routine, what do your day-to-day activities look like? Work life?
The Sky's the limit, dream big!
How many approximate steps or miles of walking do you get in a day?
Regarding nutrition, describe your current eating habits with as much detail as possible (if you track, you can send me your logs).
How many times a day do you eat? If you know your macro breakdown, provide that information. What is your food adherence M-F and during the weekend? How often do you dine out?
Do you currently take any supplements? If so, list them here.
What is your experience with macro tracking?
Please Select
Beginner
Some experience
Experienced
Any nutritional needs/preferences?
vegetarian, gluten-free, paleo, etc?
Prenant or nursing?
yes
no
Do you you a tracking device and/or app to track steps, log food, etc? If so, what do you use?
List any medical concerns you have that could be important details to consider for nutrition and/or weight training programming.
Do you have thyroid issues, high blood pressure or cholesterol, diabetes, etc? if none, type "none."
What concerns do you have about this next step you are taking to exercise? What makes you worried or nervous that I should know about?
Have you previously worked with an online trainer/coach or in person? If so, describe your experience.
What type of coaching and support works best for you? What motivates you? What demotivates you?
What excites you about this journey? What do you want this journey to look or feel like in 3-6 months? What does success look like for you?
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