Online Coaching Onboarding Questionnaire
Built by Coach Joss
Full Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Gender
Male
Female
Prefer not to respond
Date of Birth
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a year
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
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1991
1990
1989
1988
1987
1986
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1981
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1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Age
Years
Height
Inches
Weight
Lbs
What is your occupation?
How would you describe your daily activity level?
Sedentary (desk job with little to no exercise)
Lightly active (desk job with light exercise for 30 mins per day 3-5x per week)
Moderately active (moderately physically demanding job or desk job with moderate exercise 1 hour per day 3-5x per week)
Very active (consistently physically demanding job or desk job with intense exercise for 1 hour or moderate exercise for 2 hours per day per day 3-5x per week)
What is your work schedule (ex: regular 9-5, shift rotations, overnights, etc.)
Please list any recreational activities (ex: sports) you take part in (excluding physically demanding jobs and gym):
If you have any diagnosed health problems, please list the condition(s):
If you are on any medications, please list them below:
What additional physical therapy is being undertaken for the listed medical diagnosis (ex: physiotherapy, chiropractic therapy, etc.)?
If you have any injuries, please list them below:
What additional physical therapy is being undertaken for the listed injury (ex: physiotherapy, chiropractic therapy, etc.)?
How would you assess your stress levels on a daily and consistant basis:
Low
Moderate
High
Would you identify yourself as a smoker (ex: cigarette, cannabis, vaping)?
Yes
No
Social smoker only
Your current diet could be best characterized as:
Low-fat
Low-carb
High-protein
Vegetarian/Vegan
No special diet
Please rate your readiness for change (1 being resistant to change and 10 being highly motived):
1
2
3
4
5
6
7
8
9
10
Which of the following best fits your fitness goals (select all that apply)?
Fat loss
Improved health
Improved fitness
Increased strength
Improved confidence
Increased muscle mass
TImeline for achieving your goal.
Rows
12 WKS
16 WKS
24 WKS
32 WKS
40 WKS
1 YEAR
NOW
How much time in a day are you willing to invest in your health and fitness?
1 hour max
1-2 hours
1-3 hours
Whatever it takes to reach my goal
Have you trained with an online coach before?
Yes
No
When is your ideal training time given your daily routine?
Morning
Mid-Day
Afternoon
Evening
Online Coaching Packages:
Lifestyle Coaching (3-Month Package) @ $900.00 (HST not included)
Lifestyle Coaching (6-Month Package) @ $1,500.00 (HST not included)
Lifestyle Coaching (12-Month Package) @ $2,700.00 (HST not included)
Comp. Prep Coaching (6-Month Package) @ 2,100.00 (HST not included)
Submit
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