Coaching Consultation Questionnaire

Full Name

First NameLast Name

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Email

example@example.com

Gender

Date of Birth

MonthDayYear

Age

years

Height

Feet and

Weight

Lbs

What is your occupation?

Whats the activity level at your job?

Do you follow a regular working schedule, do you work days, afternoon or nights?

How often do you travel?

Why are you interested in coaching?

Please list the physical activities that you participate in outside of the gym and outside of work.:

What is your Training Age? (how long have you been training)

Are you on any medications? If so, please list them.

If you have any injuries, please list them.

Have you received or are currently receiving treatment for the given injury?

Are you experiencing any stresses or motivational problems?

How would you characterize your current diet

What following goals does best fit in with your goals?

What training styles are you most interested in?

Are you interested in competing in any of the previously listed categories?

What is your goal with your training?

Why?

What is your desired timeline for reaching this goal?

Are you currently exercising regularly (at least 3x per week)?

Have you trained with a coach/trainer before?

What kind of training did you do?

Please rate your motivational level to do what it takes for reach your goal.

Are you interested in In-Person or Online Coaching?

At what times during the day would you prefer to train?

What are your expectations for me as your Coach?

With your current budget and schedule click all possible options that would fit you best.

In-Person Coaching Rates (Includes full program design, weekly check-ins, video break downs and nutrition consultation)

Online Coaching Options

Please detail any additional information that you may feel is necessary to share.

1.) CANCELLATIONS

Training/Coaching sessions that are not rescheduled or cancelled at least 12 hours prior to the session will result in a forfeiture of the session and a loss of the financial investment at the rate of one session. In the event of an emergency, a session will be credited back at the discretion of the Business.

2.) LATE ARRIVALS

Each session shall be 1 hour in length. Sessions will not be extended (unless time is available) due to the lateness of the client or due to interruptions caused by the client.

3.) ALL THE INFORMATION I HAVE GIVEN IS CORRECT

All the information on this form is correct and to the best of my knowledge. I have sought and followed any necessary medical advice. I understand that all the information given will be kept confidential.

I AGREE TO THE ABOVE TERMS & CONDITIONS!