New Client Registration Form

Details:

Full Name

First NameLast Name

Phone Number

+44Phone Number

Emergency/ Next of kin

+44Phone Number

Age

E-mail

example@example.com

Gender

Other

Where are you based? (Country) - online coaching

How did you hear about me?

Please list your height (in cm), weight (kg) and body fat percentage (if known)

Has your doctor ever said that you have high blood pressure?

Have you ever suffered from heart disease, stroke or elevated cholesterol?

Are you currently on any prescribed medication? Does it affect your training?

Have you had any blood tests in the past 6 months? Was there anything to be concerned about?

Are you currently seeing any medical specialists at the moment? Please elaborate

Do you have or have you ever suffered from diabetes?

Are you pregnant or have given birth in the past 6 months?

Please list any muscular or joint injuries, aches, limitations or pains

How long have you been training for?

Have you followed an exercise program before?

If you have trained previously, what are the strongest lifts you have done?

What’s the most weight you have lifted whilst benching, deadlifting, squatting etc, please also add reps if you know them

How many times per week will you commit to your training program?

What time of day is the best time to train for you?

Times available for a session with me

Please list your goals and give a brief description on what they mean to you

Do you have a deadline/ target for achieving your goals ?

A wedding, fitness test, photoshoot etc

Please state what you are struggling with the most at the moment

anxiety, confidence in a gym environment, weight loss, weight gain, self confidence

How many hours of sleep do you get (on average)per night?

What is your occupation? What are the demands of your role physically and mentally?

How much time do you have to rest? And what activities do you do to relax?

slow walk, gaming, games, movies

What is the time frame between your last meal and your bedtime?

Please select all that you take on a regular basis

Do you have any food intolerances or allergies?

Please explain as best as you can what your diet is like

have you tried vegan? Vegetarian? Meat only? Do you enjoy eating high protein? Do you struggle to get protein in? Do you eat clean? Do you have many takeaways?

Do you suffer from:

Are you willing to try training with me for at least 3 months?

How serious are you to committing to your goals? Please answer truthfully

you must be prepared to alter diet, training, daily habits, routines etc

Is there anything that hasn’t been mentioned that could potentially effect your health and well being in relation to your training program

Online Coaching or Personal Training