LiftsWNyssa | 1:1 Coaching

1:1 Coaching Application

LiftsWNyssa
Part 1. Basic information
Full Name

First NameLast Name
Gender
Date of Birth

MonthDayYear
Age
years
Height
cm
Weight
KG
Part 2. Lifestyle Information
What do you do for a living?
Whats the activity level at your job?
Do you follow a regular working schedule, do you work days, afternoon or nights?
How often do you travel?
Please list the physical activities that you participate in outside of the gym and outside of work
Part 3. Medical and Health Information
If you are on any medications, please list them.
If you have any injuries, please list them.
Are you experiencing any stresses or motivational problems?
Do you suffer from diabetes, asthma, high or low blood pressure?
Are you a current cigarette smoker?
Your current diet could be best characterized as:
Part 4. Goals
Please rate your readiness for change.
What following goals does best fit in with your goals?
What is your goal with your training? Why?

TImeline for achieving your goal.

Rows	8 WKS	16 WKS	24 WKS	32 WKS	40 WKS	1 YEAR
NOW

How often are you willing to train a week to reach your goal?
Please rate your motivational level to do what it takes for reach your goal.
Are you currently excersising regulary (at least 3x per week)?
Have you trained with a personal trainer before?
What kind of training did you do?
How often do you want to do Personal Training a week?
Please Choose
At what times during the day would you prefer to train?

Other
What are your expectations on me as your Personal Trainer?
Please Read The Following Terms and Conditions
1.) CANCELLATIONS

Cancellations should be made at least 24 hours in advance of a scheduled session. Sessions cancelled less than 24 hours in advance will be charged in full to the client.

2.) LATE ARRIVALS

Each session shall be 1 hour in length. Sessions will not be extended (unless time is available) it is important to communicate when running late.

3.) ALL THE INFORMATION I HAVE GIVEN IS CORRECT

All the information on this form is correct and to the best of my knowledge. I have sought and followed any necessary medical advice. I understand that all the information given will be kept confidential.
I AGREE TO THE ABOVE TERMS & CONDITIONS!
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1:1 Coaching Application