Online/168 New Client Setup Questionnaire

Online/168 New Client Setup Questionnaire

All information on this form is confidential and is used for coaching purposes only
Name

First NameLast Name
Phone Number
Format: (000) 000-0000.
Email
example@example.com
Which of the following equipment do you have/are willing to acquire at home?

Other Pieces (List)
If preferred, add photo of workout space/equipment that will be used for exercise program.

Health & Lifestyle

Rows	Yes	No
Do you smoke?
Do you drink alcohol?
Are you using any additional vitamin or supplements?
Are you tracking your daily food intake?
Do you feel pain while doing sports/exercise?

Answer the following on a scale of never (0) to always (5)
Planning my meals for the day/week

0

1

2

3

4

5

0 is Never, 5 is Always
Eat meals out/at restaurants

0

1

2

3

4

5

0 is Never, 5 is Always
Eat consistently throughout the week

0

1

2

3

4

5

0 is Never, 5 is Always
Train consistently

0

1

2

3

4

5

0 is Never, 5 is Always
Train with intensity/purpose

0

1

2

3

4

5

0 is Never, 5 is Always
How often can you exercise per week?
Exercise would be considered at least 20 minutes of moderate effort
Please select the best days for you to workout
Please select your preferred time of day to workout
How long do you prefer to train on average?
What are your goals for training?

Other
From these goals, please briefly identify the top 2 and why they're important
(all answers are confidential!)
Please list and explain any and all injuries/restrictions you encounter while exercising. Be as specific as possible with regard to exercises/movements that provoke pain along with the length of the issue.
Should be Empty:

Answer the following on a scale of never (0) to always (5)