Programming Only Coaching Inquiry Form

1
Contact InformationPlease provide your contact information. These are the ways we will communicate.
Please enter your WhatsApp phone number. This is where any communication between us will take place.
Please enter your Google email. This is where I will send your custom program.
2
Personal InformationPlease answer these questions honestly so I can get an idea of you as an athlete.
Please enter your first and last name.
Please enter your age and birthdate.
Please enter your height followed by your most current bodyweight.
3
Location InformationPlease answer these questions with your most current information.
Please enter your current city.
Please enter your current state.
4
Athlete InformationPlease answer these questions honestly so I can understand where our starting point lies.
Please Select
Please Select
Yes
No
Have you ever competed in a powerlifting meet?
If so, how many times have you competed and when was your most recent meet?
If so, what weight class did you compete at and what did you total at your most recent meet?
5
Current Lifting InformationPlease answer these questions honestly so I can understand where our starting point lies.
What is your most current gym sqaut max?
What is your most current gym bench max?
What is your most current gym deadlift max?
In great detail, describe what your current training looks like.
6
Athlete Goals* This field is required.Briefly, list your goals as a powerlifter along with what you hope to gain from working with me. Be as specific or as broad as you would like.
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Large
Normal
Small
Ok
Ok
7
Health InformationPlease answer these questions honestly. *THIS INFORMATION WILL NOT AFFECT MY DECISION ON TAKING YOU ON AS AN ATHLETE*
In detail, please describe any and all pain/injuries you currently have or have had in the past with a timeline.
Please Select
Please Select
Yes
No
Have you ever used a performance enhancing substance?
If so, what did/are you using and how long did/have you been using it?
Please Select
Please Select
Yes
No
Are you prescribed any medication from your doctor?
If so, elaborate.
8
Availability Information* This field is required.What days are you able to CONSISTENTLY train on?
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
9
Background InformationPlease answer this question completely.
Please provide your social media handles. These will be used as a background check.
10
Starting Information* This field is required.If taken on, when are you able to start training under me?
Date
Month
Day
Year
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