Personal Coaching Consultation Questionnaire
Full Name
First Name
Last Name
Instagram account
First Name
Last Name
Gender
Male
Female
Age
years
Height
cm
Weight
KG
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)
Do you follow a regular working schedule, do you work days, afternoon, or nights?
Please list the physical activities that you participate in, outside of the gym and outside of work. (i.e hiking, swimming etc.)
If you have any diagnosed health problems list the condition(s).
If you are on any medications, please list them.
What additional therapies are being undertaken for the given health problem(s)?
If you have any injuries, please list them.
What additional therapies are being undertaken for the given injury?
Has anyone of your immediate family developed heart disease before the age of 60?
Yes
No
Do any diseases run in your family?
Yes
No
Do you suffer from diabetes, asthma, high or low blood pressure?
Yes
No
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
Please rate your readiness for your transformation.
1
2
3
4
5
6
7
8
9
10
What following specialties best fit with your goals?
strength training
Building muscle
Fat loss
Self defense
What is your goal with your coaching?
Why?
TImeline for achieving your goal.
Rows
2 months
4 months
6 months
8 months
10 months
1 YEAR
NOW
How often are you willing to train a week to reach your goal?
Are you currently working out?
Yes
No
Have you trained with a personal coach before?
Yes
No
What kind of coaching did you do?
At what times during the day would you prefer to train?
Morning
Mid-Day
Afternoon
Evening
How often do you want to train a week?
Please Select
1 Session
2 Sessions
3 Sessions
4 Sessions
5 Sessions
6 Sessions
7 Sessions
Please Choose
What are your expectations on me as your Personal Coach?
Are you experiencing any stresses or motivational problems?
Yes
No
Please rate your motivational level to do what it takes for reach your goal.
1
2
3
4
5
6
7
8
9
10
Submit
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