Weightlifting Coaching Enquiry Form
1. Personal Information
Name
*
First Name
Last Name
Date of birth:
*
-
Month
-
Day
Year
Date
Gender:
*
Please Select
Female
Male
Prefer not to say
Weight:
*
enter in kg
Height:
*
enter in cm
Contact number:
*
enter in kg
Email
*
example@example.com
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2. Weightlifting History
How long have you been Weightlifting? Or are you a beginner looking to try it out?
*
What are your current best numbers?
*
Snatch, Clean & Jerk, Front & Back Squat, Power Clean & Snatch etc
How many times a week are you able to commit to training?
*
If yes, give as much detail as possible about the days/times you work/study
How active are you throughout the day, in your work or study?
*
I'm sat down most of the day
A mixture of being stood up and sat down
I'm stood up most of the day
I'm very active for most of the day
I do a lot of heavy lifting
Other
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3. Health/Medical Information
Do you have any diagnosed health/medical conditions that I should be made aware of?
*
Yes
No
If you do, please list them here. Be as detailed as you can about, what it is, how it affects you and how you are managing your symptoms
Have you had any injuries or niggles recently or in the past that I should be made aware of?
*
Yes
No
If you do, please list them here. Be as detailed as you can about, what it is, how it affects you and how you are managing it
Do you smoke?
*
Yes
No
Occasionally
Other
Do you drink alcohol?
*
Yes
No
Occasionally
Other
How many hours of sleep do you get on average per night?
*
4 hours or less
5-7 hours
8+ hours
I don't know
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4. Your Goals
Are you interested in?
In Person Coaching
Online Weightlifting Programming/Coaching
What are your goals in Weightlifting? Short, medium and long term?
*
Give as much details as possible about any specific, measurable goals you have
If you achieve these goals, how will it affect your life?
*
Give as much details as possible
What, if anything, has stopped you in the past from achieving these goals?
*
Give as much detail as possible
Why choose MPB Coaching? What made you gravitate towards us for Weightlifting Coaching?
*
Give as much detail as possible
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5. Nutrition
Do you want any help from me with nutirtion?
*
Yes - Weight management
Yes - Muscle growth
Yes - Making better food choices
No thanks
What specifically would you like support with?
*
Give as much detail as possible. If you answered 'No' then type 'Not Applicable'
Has anything been successful for you in the past diet and nutrition wise?
*
Do you have any dietary restrictions?
*
List any allergies, intolerances, medical conditions causing restrictions
What have you struggled with in the past diet and nutrition wise?
*
Have you tracked calories before?
*
Yes - MyFitnessPal
Yes - another app
No
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6. Training Sessions
How many times a week do you currently train?
*
Zero
1-3 days per week
3-5 days per week
6-7 days per week
How long have you been training?
*
less than 6 months
6 months - 1 year
1-2 years
2+ years
Other
If you do other kinds of training than Weightlifting what are they?
*
Weight training in the gym
Gym classes
Crossfit/Functional Fitness
Running/Cycling/Cardio Training
Yoga/Stretching/Mobility Training
Home/Outdoor workouts
Personal Training sessions
Other
How many training sessions a week are you willing to do on this programme?
*
2 per week
3 per week
4 per week
As many as needed to reach my goals
What days/times are you currently available to train during your programme ?
*
Rows
6am-9am
9am-12pm
12pm-3pm
3pm-6pm
6pm-9pm
9pm-12am
Not available
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Is there anything else that could affect your aility to participate Weightlifting?
*
i.e. holidays, religious obligations, childcare etc.
Is there anything specific you want to be able to achieve in your sessions? Something you want to do that you can't now?
*
i.e. snatch 100kg, Push press 125kg etc
Is there anything you DON'T want to do on this programme?
*
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