Online Coaching Application
Helloš«” This form will take 3 minutes to complete. You will be redirected after to book a 1-1 online call with our head coach Anthony so you can discuss your goals further. We can then provide you more information on the packages we offer and what we feel would be the best fit for you.
Full Name
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First Name
Last Name
What is your age?
Email Address
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example@example.com
What are your goals? Tick all that are applicable.
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Build Muscle
Lose Fat
Get Fitter
Get Stronger
More Toned
What is your training experience?
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Beginner
Intermediate
Advanced
What type of exercise do you like to do?
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Weight training in a gym
Home workouts
Cardio
Sports
High intensity training
Other
How many training sessions per week can you complete given your work/study schedule?
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1-2
2-3
4-5
6-7
Can you provide more detail on which type of exercise?
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Do you currently track your calorie intake?
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Yes
No
If 'yes' - how many calories a day do you consume?
If 'no' - would you be open to tracking your calorie intake?
Have you used 'MyFitnessPal' before or another calorie tracking app?
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Yes
No
Have you ever tracked your protein intake or do you have experience with this?
Do you currently track your steps?
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Yes
No
If yes - how many steps a day do you do approximately?
If 'no' - would you be open to tracking your steps?
Do you have any dietary preferences? (e.g vegetarian, gluten intolerance, allergies etc.)
What is your current bodyweight? If you don't know - please leave this box blank.
How tall are you?
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If you have a goal of losing weight - how much would you like to lose and in what time frame e.g 15KG in 12 weeks...?
If you would like to train at home - what equipment do you have?
Let us know more about your fitness goals and expectations. You can also provide further information in this box you feel is important for us to know.
What annoys/frustrates you in regards to your current health and fitness?
Check the conditions that apply to you:
Asthma
Cancer
Cardiac disease
Diabetes
Hypertension
Psychiatric disorder
Epilepsy
Other
Are you currently taking any medication?
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Yes
No
Please list them if applicable.
What is the best way to contact you following submission of this form? (Instagram, what's app, email etc)
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I am happy for PhysiqueLevels to contact me via email
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Yes
No
Submit
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