Free Call for Personal Training with Coach Carissa at Relentless Fitness
Client Name
First Name
Last Name
Birth Date
-
Month
-
Day
Year
Date
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Email
example@example.com
Emergency Contact Name
First Name
Last Name
Emergency Contact Phone Number
Please state if you have current/previous health diseases/issues.
Please state whether you take any medication.
Health & Lifestyle
Yes
No
Do you smoke?
Have you had any surgery since one year?
Do you drink alcohol?
Are you using any additional vitamin or supplements?
Are you tracking your daily food intake?
Have you done sports professionally before?
Do you feel pain while doing sports/exercise?
At which frequency you eat at night?
Never
0
1
2
3
4
Always
5
0 is Never, 5 is Always
At which frequency you eat breakfast?
Never
0
1
2
3
4
Always
5
0 is Never, 5 is Always
What is your rate for your nutrition?
Poor
0
1
2
3
4
Excellent
5
0 is Poor, 5 is Excellent
How often can you exercise per week?
How many months will you do exercise?
Please select the reasons you eat (besides hunger).
Stress
Depression
Boredom
Happiness
Habit
Annoyance
Please select the best days you can exercise.
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Please select the best times you can exercise.
Early Mornings
Mornings
Early Afternoons
Afternoons
Evenings
What are your goals for training?
Development of muscles
Reducing the stress
Losing body fat
Increasing the motivation
Training for an event/specific sports
Other
If you were to start coaching with me, what are 3 key things you would really like to achieve?
To create sustainable change requires conscious and consistent effort to made within the coaching program; how ready are you to make the changes required to take back your health?
Not at all!
1
2
3
4
5
6
7
8
9
100% ready to feel stronger within my body!
10
1 is Not at all!, 10 is 100% ready to feel stronger within my body!
Can you think of any reason besides what's been listed as to why you might not achieve the results that you want from this program?
If there's any other information that you feel is relevant, please use the space below.
How did you hear about me / my personal training & coaching services?
Thank you.
You'll now be re-directed to book in your free call with Carissa, to see if we are a good fit for coaching together. Please make yourself available for this call, as coaching spots are limited and we'd hate for you to miss your opportunity for a healthier, happier version of you!
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