Online Training Consultation Questionnaire

This form is for all my potential online clients. Please fill it out as thoroughly as possible to help me determine the best approach for you to reach your fitness goals. Once you’ve completed the form, you can set up a time using my Calendly link, and we’ll discuss the next steps in detail.

Full Name

First NameLast Name

Email

example@example.com

Gender

Date of Birth

MonthDayYear

Age

years

Height

cm

Weight

KG

What do you do for a living?

Whats the activity level at your job?

Please list the physical activities that you participate in outside of the gym and outside of work.:

If you have any diagnosed health problems list the condition(s).

If you are on any medications, please list them.

What additional therapies are being undertaken for the given health problem(s)?

If you have any injuries, please list them.

What additional therapies are being undertaken for the given injury?

Are you experiencing any stresses or motivational problems?

Has anyone of your immediate family developed heart disease before the age of 60?

Do any diseases run in your family?

Do you suffer from diabetes, asthma, high or low blood pressure?

if yes please list:

Are you a current cigarette smoker?

Your current diet could be best characterized as:

What following goals does best fit in with your goals?

What is your goal with your training?

From 1-10 How Committed Are You To Accomplishing Your Goals?

Why?

TImeline for achieving your goal.

Rows	8 WKS	16 WKS	24 WKS	32 WKS	40 WKS	1 YEAR
NOW

How often are you willing to train a week to reach your goal?

Are you currently excersising regulary (at least 3x per week)?

What is your current budget for online coaching?

Book your call time here! https://calendly.com/fitcoachmoe53/30min