Fitness Coaching Consultation
Empowering Women with Strength, Confidence, and Wellness
Part 1. Basic information
Full Name
First Name
Last Name
Gender
Male
Female
Age
years
Height
cm
Weight
Part 2. Lifestyle Information
What do you do for a living?
Whats the activity level at your job?
None (seated only)
Moderate (light activity such as walking)
High (heavy labor, very active)
How often do you travel?
Rarely
A few times a year
A few times a month
Weekly
Please list the physical activities that you participate in outside of the gym and outside of work
Part 3. Medical and Health Information
If you have any diagnosed health problems list the condition(s).
If you are on any medications, please list them.
If you have any injuries, please list them.
Are you experiencing any stresses or motivational problems?
Yes
No
Has anyone of your immediate family developed heart disease before the age of 60?
Yes
No
Do you suffer from diabetes, asthma, high or low blood pressure?
Yes
No
Please list:
Are you a current cigarette smoker?
Yes
No
Your current diet could be best characterized as:
low-fat
low-carb
high-protein
Vegetarian/Vegan
No special diet
Part 4. Goals
Which of the following goals best fit in with your goals? Multiple can apply.
Improved health
Improved endurance
Increased strength
Increased muscle mass
Fat loss
Injury Rehabilitation
What is your goal with your training? Why?
What obstacles have kept you from reaching your goals?
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?
Please rate your motivational level to do what it takes for reach your goal.
1
2
3
4
5
6
7
8
9
10
Are you currently excersising regulary (at least 3x per week)?
Yes
No
Have you trained with a personal trainer before?
Yes
No
What kind of training did you do?
Where will you be working out?
In the Gym
At Home (body weight only)
At Home (with equipment)
Mix of in the gym and at home
How many days will you realistically workout per week?
Please Select
1
2
3
4
5
6
Please Choose
How long are your current workouts?
Please Select
30 minutes of less
45 minutes
1 hour
1+ hours
NA
Please Choose
What are your expectations on me as your Personal Trainer?
What is your instagram handle?
List your phone number and email so I can schedule your FREE consultation call. 🫶
I'M READY TO LIVE MY BEST LIFE! 💪
Let’s Gooooo
I need more information
What if I can’t afford it?
Nah, I’m scared of greatness
Submit
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