New Customer Registration Form
Customer Details:
Full Name
*
First Name
Last Name
Phone Number
*
Format: (000) 000-0000.
E-mail
*
example@example.com
Gender
*
Female
Male
Age
*
Location (City/Time Zone)
*
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2. Health & Medical History
Do you have any current or past injuries?
*
Yes
No
Have you had surgery in the past 5 years?
*
Yes
No
Do you have any chronic medical conditions? (e.g. asthma, diabetes, hypertension)
*
Yes
No
Are you currently taking any medications?
*
Yes
No
Do you experience pain during exercise? If yes, please describe.
*
Yes
No
Do you have any limitations or physical restrictions?
*
Yes
No
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3. Lifestyle & Activity Level
What is your occupation?
*
How many hours per day do you spend sitting?
*
Do you currently exercise regularly? If yes, what type and how often?
*
How would you describe your current fitness level?
*
Beginner
Intermediate
Advanced
4. Goals & Motivation
What are your primary fitness goals? (Select all that apply)
*
Weight loss
Muscle gain
General fitness
Flexibility/mobility
Endurance/cardio
Other
Why is this goal important to you?
*
What’s your timeline for reaching this goal?
*
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💪 Training Preferences
Do you prefer:
*
Home workouts
Gym workouts
Outdoor workouts
Do you have any equipment available? (List what you have)
*
How much time can you dedicate to each session?
*
What types of training do you enjoy (or dislike)?
*
Nutrition Coaching
What does a typical day of eating look like for you? (Include meals, snacks, drinks)
*
Are there any foods you absolutely avoid? If yes, which foods?
*
How often do you consume: Sugary drinks, alcohol, fast food, processed foods?
*
What time is your first and last meal of the day usually?
*
How confident are you in meal prepping? (1–5 scale)
*
Are there any foods you love and want to keep in your plan?
*
Are there any foods you dislike or refuse to eat?
*
Do you experience any digestive issues? (Check all that apply)
*
Bloating
Constipation
Diarrhea
Reflux
Food sensitivities
None
Have you tried any diets before? If yes, what were they and how did they work for you?
*
On a scale of 1–10, how ready are you to make changes to your nutrition?
*
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Program Fit & Readiness
On a scale of 1–10, how committed are you to reaching your goals?
*
What has stopped you in the past from achieving your fitness goals?
*
What do you expect from me as your coach?
*
Are you willing to invest time and energy into your transformation?
*
When are you ready to get started?
*
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