JadeFitness Personal Training Intake Form

JadeFitness

Online Coaching Enquiry Form
Full Name

First NameLast Name
Date of Birth

MonthDayYear
Phone Number

Area CodePhone Number
Height
ft
Weight [If known]
kg
Email
Instagram Handle
What do you do for a living?
Do you follow a regular working schedule? [days, afternoons, nights]
What's the activity level at your job?
What's your overall daily activity level?

1

2

3

4

5

1 is None, 5 is High
Please list the physical activities you participate in outside of the gym and work:
What are your current health and fitness goals? [Please go into detail]
Why is it important to you that you achieve these goals?
What has prevented you from achieving these goals previously?

Timeline for achieving your goals:

Rows	3 months	3-6 months	6 months - 1 year	No timeline goal
Timeline

Have you exercised in the past? If yes, please detail your previous routine:
Do you currently exercise? If yes, please detail your routine:
Please detail what your current diet looks like [on an average day/week]:
Have you ever tracked your nutrition before?
Have you had an Online Coach before?
How often are you willing to train each week, and on what days?
Is it okay for me to post your progress photos on social media?
Are you comfortable taking progress photos?
What are your expectations of me as your Online Coach?
Please rate your readiness to change.

1

2

3

4

5

1 is Low, 5 is High
Terms and conditions:

1] Stopping coaching - if you wish to stop online coaching, please let me know at least 1 week before the end of your current programme. If you attempt to cancel any later than this, a further 4 weeks of coaching will resume before stopping can occur.

2] Communication - As your coach, i will respond to any messages/questions ASAP. Please be aware that messages outside of work hours will be replied to the following day.

3] All the information i have given is correct and to the best of my knowledge. I understand that all the information given will be kept confidential.
I AGREE TO THE ABOVE TERMS AND CONDITIONS
Should be Empty: