MelBroFitness Coaching Form
Athletes and Lifestyle Clients
Full Name
*
First Name
Last Name
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Format: (000) 000-0000.
Age
*
Birth Date
*
Height
*
Weight
*
What are your short-term goals?
What are your long-term goals?
How much of a priority are these goals in relation to other things in your life? Name any obstacles that may get in the way of your success.
What is your occupation and work/school schedule? Are you active or more sedentary throughout a work day? After work?
What is your experience with weight training? Have you tried programs in the past with positive results?
How many days are you currently training now? What's your regimen like? What is your training split?
What are the best times during the day for you to train schedule and energy wise? After how many meals?
Do you have any injuries? Are there certain exercises that you avoid?
Are you currently doing cardio? If so, what kind and duration? What type of cardio has helped you get the best results in the past?
Describe a typical days worth of eating in detail. If applicable, set it up like: Meal 1: Meal 2:
What is your current macronutrient breakdown (carbs, fats, protein, calories), if you know it? If you are following different diets for different days, please indicate. How long have you been at this intake?
Has this intake produced weight loss, gain, or maintenance? How has gym performance and energy outside of the gym been?
Any digestive issues? This includes bloating, pain, abnormal bowel movements.
When was the last time you had an antibiotic? List drug and reason.
List foods you love:
List foods you hate:
Do you have any allergies or food sensitivities? Do you notice a negative response with any particular foods (bloating, gas, pain, tiredness, joint pain)?
Are you on any prescribed medications? Please list.
Women Only - are you on birth control? Which one? Are you having a regular menstrual cycle? What is your history with regular menstrual or irregular cycles?
How would you rate your sleep? How many hours per night on average? Any issues with trouble falling asleep, staying asleep or waking up rested?
How would you rate your stress levels day to day? If you feel stress is high, do you notice you feel more anxious at particular times of the day?
List supplements and doses you are taking:
Are you currently or have you recently used performance enhancing drugs? What is your previous PED experience?
Do you drink alcohol or use recreational drugs?
Have you had blood work done recently?
If so, please attach here. No screenshots. Download the PDF.
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Please tell me exactly what you would like to get out of your experience from me. Is there anything else I should know?
Please upload front and back photos if a non-competitor. If you are a competitor, please hit all your mandatory poses. Take pics in a clearly lit room at a distance away that I can see your whole body in the shot.
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