New Client Consultation
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Date of Birth
*
/
Month
/
Day
Year
Date
Gender
*
Please Select
Male
Female
Height
*
Weight
*
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Next
Occupation
What is your occupation?
*
What is your work activity level?
*
Sedentary
Mildly Active
Active
Very Active
Does your occupation require extended periods of sitting?
*
Yes
No
Does your occupation require repetitive movements?
*
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Health
Do you have any current injuries or medical conditions?
*
(e.g., back pain, joint issues, heart conditions)
Are you currently on any medications?
*
Have you had any surgeries or major injuries in the past?
*
Do you ever feel pain in your chest when you do physical activity?
*
Yes
No
Do you lose your balance because of dizziness or do you ever lose consciousness?
*
Yes
No
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Lifestyle
How many hours of sleep do you get per night?
*
5 hours or less on average
5 to 7 hours on average
7 or more hours on average
How would you rate your overall diet to be?
*
Not Healthy
1
2
3
4
Very Healthy
5
1 is Not Healthy, 5 is Very Healthy
How many cups of water do you typically drink throughout the day? (1 cup = 8oz)
*
Worst
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Best
16
1 is Worst, 16 is Best
What is your daily stress level
*
None
1
2
3
4
Extreme
5
1 is None, 5 is Extreme
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Training
How would you explain your fitness level?
*
Beginner
Intermediate
Advanced
Do you have a preference in trainer?
Male
Female
No preference
What does your current workout routine look like?
*
What does your historical recovery ability look like?
*
Rarely sore more than 1 day after training
Often sore 1-2 days after training
Often sore 2 days after training
Often sore 3 days after training
How many days a week do you prefer to train? (what days)
*
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Goals
Why do you want to train?
*
What are your primary fitness goals?
*
Why would you like to hire a coach to work towards these goals?
*
What are your biggest obstacles when it comes to staying consistent with exercise?
*
What has worked or not worked for you in the past?
*
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