Client Interest Form
Personal Details:
Full Name
*
First Name
Last Name
Date of birth:
-
Month
-
Day
Year
Date
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Coaching & Availability
What service are you interested in?
Online
In person
Hybrid (1 in person ever fortnight - full online program)
How many days per week can you realistically train?
Preferred training times
Early Morning (before 6am)
Morning (6am-12:00PM)
Afternoon (12:00pm - 6:00pm)
Night (6:00pm-9:00pm)
What days are you available?
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Health & Pre-Screening
Do you currently have any injuries or physical limitations?
Have you had any surgeries in the last 12 months? (If yes, explain)
Do you experience pain during exercise? (if yes, please explain)
Do you have any diagnosed medical conditions?
Asthma
Diabetes
Hypertension
Heart conditions
anxiety
Other
If answered other please explain:
Are you currently taking any medications that may affect exercise?
Yes
No
Has a medical professional ever told you not to exercise?
Yes
No
Are you pregnant or postpartum?
Yes
No
Are you aware of any reason why you should not participate in physical activity or exercise?(If YES: You may require medical clearance before commencing exercise).
Yes
No
Training Background & Goals
What is your main goal right now?
Fat loss
Muscle gain
Strength
General fitness
Confidence
Why is this goal important to you?
How long have you been training? (if you are currently training please explain what you currently do)
What do you currently struggle with most?
Motivation
Nutrition
Consistency
Lack of knowledge
Time management
I understand that coaching results require consistency, effort, and communication. I confirm the information provided above is accurate to the best of my knowledge.
Continue
Continue
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