New Athlete Application
Full Name
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First Name
Last Name
Email Address
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example@example.com
Instagram/Facebook Account username
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Date of Birth
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Month
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Day
Year
Age
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Which Coaching service are you interested in applying? (No payment is required to submit this application)
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Please Select
Lifestyle Online Coaching
Weekly Competition Coaching
1-on-1 in person personal training
Are you currently working with another coach/trainer?
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Type Yes
Type No
Current Bodyweight
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Units (bodyweight)
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lbs
kg
Height
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Units (height)
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Type inches
Type cm
Please describe your weight history
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What are your short term goals over the next 8-12 weeks? OR, if you are not looking for programming, what would you like to discuss during your consultation?
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What are your long term goals?
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RESISTANCE TRAINING
Please summarize your current weight training split/regimen.
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What, if any, equipment limitations do you have/anticipate having?
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NUTRITION
Describe your current nutrition intake, include total calories, carbs, protein, and fats. If unknown, list your food intake (type and amount) for a typical day.
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Do you have any food allergies or intolerances? Any additional information relevant to your nutritional status?
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CARDIOVASCULAR WORK & ACTIVITY OUTSIDE OF GYM
Describe your typical level of daily physical activity outside of the gym. Do you have an idea of you average step count/day?
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What is you current cardio regimen? Include schedule, intensity and type.
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SUPPLEMENTATION
List all supplements you use, including their frequency and dose.
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MEDICAL HISTORY
Pleas list any medical diagnoses (e.g. Kidney disease, type II Diabetes, hypertension, PKU, etc) - If none, type N/A
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If you listed any medical diagnoses above, are those conditions stable as determined by a qualified health care professional?
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Type Yes
Type No
Type N/A
Please list any injuries or ongoing pain that currently inhibits your ability to train as desired. If non, type N/A
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Family history of medical diagnoses (Who? What? Example: Mother - Type II Diabetes):
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Medication History (Past Meds):
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List all medications you currently take (insulin, birth control, TRT, HRT, etc.), including their frequency, and dose.
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LIFESTYLE
Can you balance the time you spend focused on your food, your body weight and composition, and your nutrition plan progress with other aspects of your life such as relationships, work, and personal development?
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Please list any prominent stressors you have at this time.
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Has your weight or shape influenced how you think about (judge) yourself as a person?
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Do you have any food or exercise rituals that concern you? If yes, please explain:
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PHYSIQUE PHOTOS
Please either have someone help you take photos or use a self timer (no mirror selfies). It is also preferred to have you facing a natural light.
Current photo displaying your physique (front pose)
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Current photo displaying your physique (back pose)
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Photo from your last contest (optional, but is very useful with our evaluation of your physique)
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Should be Empty: