Work With Me — 1:1 Coaching Application
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Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Height
Weight
Not required, only fill out if you feel comfortable or have a body composition goal.
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
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Health & Medical Background
Do you have any diagnosed medical conditions?
*
Yes
No
If yes, please provide details.
List any past injuries or surgeries (including dates and any ongoing limitations)
*
Are you currently taking any medications or supplements?
*
Yes
No
If yes, please list them.
Do you have allergies?
*
Yes
No
If yes, please specify.
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Daily Routine & Lifestyle
Occupation Type
*
Sedentary (desk job)
Light Activity (e.g., teacher, salesperson)
Active (manual labor)
How many days per week do you typically work?
*
What are your typical work hours (e.g., 9 AM – 5 PM)?
*
Average hours of sleep per night:
*
Sleep quality:
*
Poor
Fair
Good
Excellent
Current stress:
*
Low
Moderate
High
Main sources of stress?
Do you have hobbies or activities outside of work and training?
Yes
No
If yes, please list them.
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Nutrition & Eating Habits
Describe your typical daily diet:
Do you follow a specific dietary plan or have any restrictions?
Vegetarian
Vegan
Gluten-Free
Keto
Other
Rate your nutritional habits (Scale 1–5)
*
Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
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Training Experience
How many years have you been consistently training?
*
Types of physical activities you have engaged in:
Weightlifting
Cardiovascular Training (Running, Cycling)
Group Classes (CrossFit, HIIT)
Sports
Yoga/Pilates
Other
Do you have experience with structured training programs?
Yes
No
If yes, please describe:
Have you worked with a coach or personal trainer before?
Yes
No
If yes, what was your experience like?
What did you enjoy most?
What did you find most challenging?
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Goals & Motivation
Primary fitness goals:
*
Fat Loss
Muscle Gain
Improve Strength
Increase Endurance
Improve Mobility/Flexibility
Performance
General Health and Wellness
Why are these goals important to you?
*
Do you have any specific performance targets?
Yes
No
If yes, please specify.
Timeline for achieving your goals:
*
Short-Term (1–3 months)
Medium-Term (4–6 months)
Long-Term (6+ months)
How committed are you?
*
Not really
1
2
3
4
Very!
5
1 is Not really, 5 is Very!
Please explain your rating.
What barriers or challenges do you anticipate?
*
How would you prefer to measure progress?
Scale Weight
Body Measurements
Performance Metrics
Visual Changes (photos)
How I Feel (energy, mood)
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How You Want to Train:
How many days per week can you commit to training?
1-2
3-4
5-6
7
Preferred training days:
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Preferred training time:
Morning
Afternoon
Evening
Where will you be training?
Commercial Gym
Home Gym
Outdoor
Available equipment if not a commercial gym:
Do you prefer variety or consistent routines?
Preferred training styles or exercises:
Exercises or activities you dislike or want to avoid:
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Coaching Style & Communication Preferences:
Preferred communication style for feedback:
Written Communication (email, messages)
Video Calls
Phone Calls
In-App Messaging
What level of accountability do you expect?
High Touch (frequent check-ins)
Moderate
Low Touch (independent)
Are you comfortable sending exercise videos for review?
Yes
No
Anything else you’d like me to know?
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Mindset & Readiness
How ready are you to make changes?
Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
Please explain your rating.
What motivates you most?
Achieving Milestones
Overcoming Challenges
Receiving Encouragement
Personal Growth
How do you typically handle setbacks or obstacles?
Describe a time you achieved a major goal.
What strategies did you use?
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Emergency Contact Details
Emergency Contact
*
First Name
Last Name
Emergency Contact Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Relationship
*
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