Online Coaching Request Form
Client Details:
Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
Suburb
State
Post Code
Email Address
example@example.com
Phone Number
04XX XXX XXX
TRAINING QUESTIONNAIRE
Age
*
Height
*
Weight
*
Body Fat % (if known)
BMR (if known)
What are your fitness goals?
*
What is your current fitness level /10?
*
Any Medical Conditions or Injuries to take into account?
*
What do you do for work and how many hours per week do you usually work?
*
Are you training in a gym or at home? If at home, what equipment do you have available?
*
How many years have you been training for?
*
What is your current training split?
*
Weekly amount of strength training sessions?
*
Weekly amount of cardio training sessions?
*
Weak areas for strength?
*
Weak areas for hypertrophy (development)?
*
Movements that are uncomfortable?
*
Short term goal (12 months):
*
Long term goal (1-5 years):
*
NUTRITION QUESTIONNAIRE
Do you have any food allergies or medical conditions? If so, what are they.
*
Current daily calorie intake (if known):
What is your current eating schedule like on each day? What times do you eat breakfast, lunch and dinner?
*
What times do you get breaks during the day?
*
What vegetables/salads do you eat?
*
What fruits do you eat?
*
What meats do you eat?
*
What starchy foods do you eat? (rice, pasta, potatoes, cereal, etc)
*
What foods do you NOT eat?
*
List a few of your current favourite meals:
Breakfast:
*
Lunch:
*
Dinner:
*
Snacks:
*
What is your current diet like? Be truthful.
*
What foods generally digest well for you?
*
What foods make you feel bloated, nauseous or tired?
*
How often do you drink alcohol?
*
How much junk food do you eat per week?
*
Submit
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