Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Please list any muscular or joint injuries, aches, limitations or pains.
*
Will you be utilizing a fitness center/gym or facility with barbells dumbbells and cardio equipment OR at home? (If at home, please list equipment you have or will have by program start date. *Adjustable dumbbells suggested but not required*
*
What is your height and weight?
Have you followed an exercise program before?
If you’re currently on a program, what days do you train and what does your exercise routine look like on those days?
How many times per week will you commit to your training program?
List your goals and give a brief description of what they mean to you
What time of the day is the best time to train for you?
When would you like to achieve your results by?
Please rate on the scale truthfully (1=Poor to 10=Excellent)
1
2
3
4
5
6
7
8
9
10
Overall energy levels
Overall stress
Mood
Anxiety
Strength/fitness
How many hours of sleep on average do you get per night
What are the main contributors to your overall stress?
Do you have any food allergies or intolerance's?
Are you interested in a standard structured meal plan OR personalized flexible macro dieting guidance?
Please choose one
Please answer the following truthfully
Confident
Somewhat Confident
Not Confident
Im prepared to track my food intake
Im prepared to fill in my training plan
Im prepared to send progress pictures as specified
Im prepared to fill in my tracking sheet
Im prepared to modify my diet
Im prepared to take supplements as necessary
Im prepared to modify my lifestyle habits
Name
*
First Name
Last Name
Signature Required
Signature provided by Client
Date
-
Month
-
Day
Year
Date
Submit
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