Coaching Application
Please fill out this form with as much detail as possible to get a better understanding of where you are at - Please also see my booking link at the end of the form and book in a time to have a chat with me!
Name
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First Name
Last Name
Email
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example@example.com
What is your phone number, Age & sex:
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Current Bodyweight
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Please tick the box if any of these apply to you
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I have Asthma
I have Diabetes
I have/had high blood pressure
I am currently carrying an injury
I have injured myself in the past which effects some movements in the gym
I commonly experience dizziness
I am currently taking medication that can effect my mood, blood pressure, equilibrium
None Of The Above
If you have ticked any of the above boxes, please explain
What is your biggest struggle right now, and how long have you been struggling with it?
Why is it important for you to make that change TODAY!?
How important are these goals to you?
Not important at all
1
2
3
4
5
6
7
8
9
It's the most important thing in my life right now
10
1 is Not important at all, 10 is It's the most important thing in my life right now
Please describe a time you were at your peak level of fitness, the time you were most happy with how you looked and felt. Describe body weight, what you were eating, how you were training, etc.
What are your short term goals (16weeks) and a long term goals (6-12months)
Please describe your current training regime
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How many days per week are you able to train?
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2-3 Days
3-4 Days
4-5 Days
5-6 Days
Other
Select your preferred training days
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
How many years of experience do you have in the gym?
Would you describe yourself as a beginner, intermediate or advanced lifter
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Beginner
Intermediate
Advanced
Other
Have you ever had a Personal trainer or Online Coach before?
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Yes
No
If Yes, describe your experience
Are there any barriers that you know of in your life that may cause you to struggle to make it to the gym? (I.e - long work hours, child's school/sport, etc)
Please describe a regular day of eating (what you consume from waking up to going to sleep - as much information as possible)
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Do you track your food on a food tracking app?
Yes
No
Do you consume alcohol on a weekly basis?
Yes
No
Select the statement/s that best describes you
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I am willing to do whatever possible to achieve my goals
My goals are important but if a social event comes up I will prioritise having fun over working out
The gym is a hobby for me, I just go whenever I want
Fitness is a lifestyle to me, it has to be consistent for my mental health to be strong
I am wanting my lifestyle to resemble fitness
Please add in any other information you see useful that may not have been covered
*
Please sign if you are happy with the information you have provided and if you agree with everything in this form.
Please book in for your consultation call with me and we can go over all of your answers and how I can best help you!
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