1-To-1 Coaching Form

1
What's your full name?* This field is required.
First Name
Last Name
2
Preferred name (Optional)
3
Phone number* This field is required.
4
Email* This field is required.
5
Preferred method of contact?* This field is required.Multiple Choice
Text
Email
Phone Call
6
Date of birth* This field is required.
Date
Year
Month
Day
7
Age* This field is required.
8
Height* This field is required.
9
Weight* This field is required.
10
Location (Country + City)* This field is required.
11
Occupation?* This field is required.
12
What are your current training goals?* This field is required.Multiple Choice
Strength & Conditioning
Fat Loss
Muscle Gain
General Health & Fitness
13
If you selected more than one goal, list them below in order of priority. Feel free to add additional goals.
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14
What does your training history look like? (how many years/ at what level and consistency/ any sports?)* This field is required.
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15
Have you ever purchased a program before or followed a tailor-made program? If 'yes,' please elaborate on the type of training done.
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How active are you outside of the gym/ sports? (include frequency throughout the week/ duration)* This field is required.
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17
Is there any exercise/s you enjoy?
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Is there any exercise/s you don't enjoy?
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19
How many days a week can you commit to a program? And how long per session?* This field is required.
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20
Picture yourself 3 months from now. Where would you like to be? What would you like to have achieved?* This field is required.
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21
Have you ever had any injuries or chronic pain that affects your ability to move/ exercise?* This field is required.
YESNO
22
If yes, please elaborate* This field is required.
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23
Have you ever had any surgeries?* This field is required.
YESNO
24
If yes, please elaborate
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Has a medical professional ever diagnosed you with a chronic disease, such as heart disease, hypertension, high cholesterol or diabetes? * This field is required.
YESNO
26
If yes, please elaborate
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27
Are you currently taking any medication?* This field is required.
YESNO
28
If yes, please elaborate
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Is there any additonal information you'd like to add?
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SignatureI understand that: - All data provided won't be shared with any third parties without my consent. - I have answered each question honestly, and my coach can only act upon the information I provided. I take full responsibility for any incorrect data that I provide. - I have provided information about all physical or mental illnesses, injuries, or impairments that could be made worse with training. - I will continue to maintain said honesty, and shall inform my coach of any injuries, pain, or impairments that may develop as a result of training. - I understand that by sending this form, I have read the disclaimer and am aware that my coach cannot be held responsible for injuries, impairments, or pain caused as a result of incorrect information I've provided.
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