Online Coaching Inquiry Form
Full Name
First Name
Last Name
Date of Birth
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Year
Age
years
Height
Weight
LBS
What do you do for a living?
Whats the activity level at your job?
None(seated only)
Moderate (light activity such as walking)
High (heavy labor, very active)
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:
If you have any diagnosed health problems list the condition(s).
If you are on any medications, please list them.
What additional therapies are being undertaken for the given health problem(s)?
If you have any injuries/aches.pains, please list them.
What additional therapies are being undertaken for the given injury?
Are you experiencing any stresses or motivational problems?
Yes
No
Please list:
What following goals does best fit in with your goals?
Improved Health
Improved Endurance
Increased Strength
Increased Muscle Mass
Fat Loss
What is your goal with your training?
Why?
TImeline for achieving your goal.
Rows
8 WKS
16 WKS
24 WKS
32 WKS
40 WKS
1 YEAR
NOW
How often are you willing to train a week to reach your goal?
Are you currently exercising regularly (at least 3x per week)?
Yes
No
Any Other Information I Should Know!
Contact Info (Phone Number or Email)!
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