Online Coaching Application Form!
Name
First Name
Last Name
Email
example@example.com
Contact phone number
Age
Gender
Please Select
Female
Male
Other
Where are you located?
Have you received coaching from a PT / Online coach in the past?
Yes
No
Other
How did you hear about MWC?
Friends/Family
Social Media
Other
What do you do for work?
How active is your job?
Not at all
A little bit
Mostly
Very
What do you want to gain from training?
General Fitness
Weight Loss
Injury Rehab
Back/Core Stabilization
Muscle Toning
Muscle Strengthening
Flexibility
Cardio Fitness
Sport Specific Training
Other
How much time do you have for each training session?
30 Minutes
45 Minutes
60 minutes
60 + Minutes
How many days can you get to the gym/exercise each week?
1
2
3
4
5
6
7
Health History: Select any existing or past conditions
Asthma
Diabetes
Chest pain/ palpitations
Low Blood Pressure
Epilepsy
Dizziness/Fainting
Arthritis
Hip Replacement
High Blood Pressure
Cardiac History
PCOS (Polycystic Ovary Syndrome)
Endometriosis
Other
Any of the above conditions current? YES/NO + details:
Any other conditions triggered by exercise? YES/NO + details:
Do you take any prescribed medication? YES/NO + details:
Have you been hospitalised in the last 12 months? YES/NO + details:
Anything/everything that directly impacts ability to exercise
Any past/current injuries or joint pain that may affect you ability to exercise at present? YES/NO + details:
Pain scale (no pain) 1-10 (extreme pain)
Please Select
1
2
3
4
5
6
7
8
9
10
Is it aggravated by exercise?
Yes
No
Have you been medically cleared?
Yes
No
Do you smoke/vape?
Yes
No
Are you pregnant?
Yes
No
Have you given birth in the last 6 weeks?
Yes
No
What are you hoping to achieve over the next few months? What are your goals?
Be as specific as possible!
Have you encountered any barriers in your training previously/recently?
This can be lifestyle, mental, social etc.
Are you willing and ready to commit to putting in the work to become the best version of yourself?
Hell yeah!!
On the fence...
I might give it a bit more time
Are you willing to invest between $25-$35 per week to reach your goals?
Absolutely, whatever it takes!
I can't quite invest that amount of $$ right now
Anything you would like to add?
Submit
Should be Empty: