CopeFitness Coaching and Program Application

CopeFitness Coaching and Program Application

Unlock your potential with a custom training plan and expert support. Fill out this application to help me understand your goals, experience, and how I can best guide your fitness journey. All responses are confidential and will be used to tailor your program.
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Preferred method of contact
Gender
Age
Weight (lbs)
Height (e.g., 6 ft 2 in)
Any current medical conditions or injuries?
If answered yes above, please specify.
Are you currently taking any medications and supplements? (If yes, please list)
Have you had any surgeries or injuries in the past 5 years? (If yes, please describe)
What are you interested in?
How many days per week do you currently exercise?
Please describe your current workout routine and past experience (days/week, type of training, accessible gym equipment, etc.).
Please describe your current nutrition/eating habits.
How many hours do you typically sleep each night?
What are your primary fitness goals? (select all that apply)

Your job/occupation

What's your why? In other words, why are you interested in 1-on-1 coaching?
What is the biggest challenge you face that keeps you from fulfilling your goals?
How do you currently track your progress? (App, journal, none)
Is there anything else I should know to help you succeed?
What do you expect out of me as your coach? What would make this 1:1 training experience a success for you?
On a scale of 1-10, how motivated are you to achieve your goals?

1

2

3

4

5

6

7

8

9

10

1 is Not much, 10 is Very
Release & Acknowledgement

I hereby acknowledge that the information I have provided above is complete and accurate. I understand the risks associated with participating in the CopeFitness training program and accept full responsibility for any injuries or undesired situations that may occur during training. I am aware that all information submitted in this form will be kept confidential.

I recognize that I am solely responsible for any injuries sustained during the fitness program and for any incorrect or incomplete information provided. I release and discharge CopeFitness from any liability related to disclosure of my personal information as provided in this intake form.

If any of my health, lifestyle, or personal circumstances change in a way that may affect my ability to safely participate in training, I agree to inform CopeFitness staff immediately.
I have read and agree to the Release & Acknowledgement above.
Should be Empty:

Release & Acknowledgement