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Precision Coaching and Nutrition Questionnaire 🎯 🏆
Help me understand your fitness and nutrition needs to tailor a personalized program for you. Don't worry, it won't take long. 😉
Basic Information
Full Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Age
*
Gender
*
Male
Female
Desired Service
*
Instagram User (Optional)
Your Goals & Exercise Appraisal
Experience Level
*
Please Select
Beginner
Intermediate
Advanced
Returning after injury
Returning after long break
Which current physical activities do you currently engage in?
*
How many days per week do you exercise?
*
Please Select
0 Days Per Week
1 Day Per Week
2 Days Per Week
3 Days Per Week
4 Days Per Week
5 Days Per Week
6 Days Per Week
7 Days Per Week
What would you like to achieve from my program?
*
What's your desired timeframe for meeting your goal(s)?
*
Other Factors
This section is only to assess workout structure on my end. This does NOT determine if a workout prescription or nutrition plan can be provided. We'll make it work. 💪.
What Equipment Do You Have Access To? (Disregard for 1:1 In-Person Sessions)
Which supplements do you currently use, if any? (Optional, or N/A If None)
Medical Information
Do you have any food allergies or intolerances? (N/A If No)
*
Do you have any medical conditions that affect your training or nutrition?
*
Yes
No
If yes, please specify your medical conditions (N/A If No)
*
Physician Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Fortune Favors The Bold
-Virgil
What preferences do you have in mind for yourself? What challenges you the most that make it harder to reach your goals? Remember, we're here to overcome, not judge. Let's do this! 🏋️♀️🏋️🍎
*
Preference Example: I like simple workouts I can follow at my own pace.
*OPTIONAL* What time works best for a scheduled phone call? (with pending approval)
Submit Questionnaire
Clear All Questions
Should be Empty: