INFO FOR ONLINE COACHING
Let me get to know you more so we can build an online coaching plan tailored to your needs
PERSONAL INFORMATION
Name
*
First Name
Last Name
Mobile Number
*
Gender
*
Male
Female
Prefer not to say
Email
*
example@example.com
GOALS
What is your overall goal?
*
Tell me more about why you want to get started?
CURRENT FORM
Height in cm
*
Your height in cm
Weight in kg
*
Your weight in kg
HEALTH
On average how many hours do you sleep per night?
*
Do you have trouble getting to sleep at night?
*
Do you feel as though your sleep is of high quality?
*
Do you have any injuries that I should know about?
*
No
Shoulder
Elbow
Wrist
Back
Lower Back
Abs
Knee
Other
Please specify
Describe your injuries ...
LIFESTYLE
What is your occupation?
*
Does your job include shifts?
Yes
No
NUTRITION AND SUPPLEMENTATION
Favourite foods?
*
What foods would you like to be incorporated into your plan?
*
Favourite snacks?
*
Do you currently track your food?
*
Yes
No
How many calories do you have per day?
Please provide a 3 day food diary
*
How many litres of water do you consume per day?
*
How many servings of veg do you have per day?
*
Do you have trigger foods that cause you to over eat or binge? Anything that would lead you to non compliance of your nutrition plan
*
Yes
No
What foods cause you over eat or binge?
How often do you consume alcohol?
*
Never
Rarely
Frequently
Every week
Do you take any vitamins or supplements?
*
Yes
No
Please specify
Do you smoke?
*
Yes
No
How many cigarettes do you smoke per day?
ACTIVITY LEVEL
Free time and exercise
*
Sedentary (zero activity)
Light Exercise (1-2 days per week)
Moderate Exercise (3-5 per week)
Heavy Exercise (6-7 days per week
Athlete (2x per day)
Occupation
*
Mainly sitting - Student or working in an office
Mainly standing working, and some walking during the day
Stands or walks around almost all day - e.g waiter or cleaner etc
Hard physically demanding work - manual labour or construction worker etc
Do you use a step tracking device?
*
Yes
No
How many steps do you walk per day?
How much cardio do you currently do per week?
*
How many times per week can you commit to the gym?
*
3
4
5
6
How long can you spend training per day?
*
What days do you usually workout?
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
When do you usually workout?
Morning
Before noon
Noon
Afternoon
Evening
Night
DIET PREFERENCES
Preferences
Vegan
Vegetarian
Pescetarian
Halal / No pork
No supplements
No red meat
Allergies
Fish allergy
Shellfish allergy
Milk allergy
Soy allergy
Nut allergy
Lactose intolerance
Gluten intolerance
Other
Please specify
WORKOUT PREFERENCES AND EXPERIENCE
Do you have any particular movements which you enjoy or find easy to progress with?
*
Yes
No
Please specify
Are there any exercises that you do not connect well with or struggle doing?
*
Yes
No
Please specify
What body areas would you like to focus on most?
*
Do you have any specific days that should be kept as non training days?
*
Yes
No
What days?
How many days can you work out?
*
3
4
5
6
How experienced are you with strength training?
*
I am a beginner or have only trained a few times
I have trained for some time and know the basics
I have trained for more than two years and feels confident in the gym
Where do you want to workout?
*
Gym
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