Online Coaching Intake Form

Online Coaching Intake Form

Fill out completely and allow a 48hr response via Email.
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Date Of Birth

MonthDayYear
Date
What do you wish to accomplish in our time together?
Goals, Mindset shift, Macro counting, Training, etc
How capable are you of executing your protocol? Checking in every week as your coach expects you too?
1-10 10 being extreme effort. I don't expect perfect, but expect maximum effort.

When do you have time commitments outside training? (Work, Volunteer, Church etc) Note activity with single word

What time of day do you prefer to train?
How many hours of sleep do you currently get? Is this quality sleep?
What is your average day step count?
Health app provides an average step count.
Are you currently on any training program, meal plan? If so describe it. If N/A describe your current eating/lifestyle.
List all the current supplements you use
Protein, Creatine, Glutamine, BCAAS, etc.
Do you drink alcohol? (If so how often and how many drinks)
Any medical conditions, injuries, or physical limitations?
FEMALE ATHLETES: Are you currently on Birth Control?
If yes, which kind and for how long? Any issues with Birth Control?
Have you had a regular menstrual cycle more than 3 months?
Any other information you feel is important for me to know to better address your goals, note below.
By proceeding, I understand this is a personalized program for one-on-one online coaching. I affirm that I am ready to invest in myself and make a financial invest to my health. I take full ownership of working with a coach and its responsibilities. I recognize I will be held to a high standard.
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