Coaching Intake Questionnaire
This is step one on your journey
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
What are your primary goals? (Be specific)
On a Scale of 1-10 how committed are you to reach these goals?
What is your target timeline for seeing results?
Have you ever hired a coach before? If so what do you like/dislike about the experience?
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How many days per week can you train?
2-3 days
4 days
5 days
6 days
It varies
How much time do you have per workout?
30 minutes or less
45 minutes
60 minutes
75+ minutes
Current activity level (outside of working out)
Sedetary
Lightly active (5k-8k steps)
Moderately active (8k-12k steps)
Very active (12k+ steps)
Daily average hours of sleep
4-5 hours
6-7 hours
8 hours
8+hours
How would you rate the quality of your sleep on a scale of 1-10. (10 being the best)
Stress level 1-10 (1 being the best)
What is your main source of stress?
Do you currently track your food?
Yes
No
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Do you have and current injuries, pain, or medical conditions? (e.g. lower back pain, knee issue, shoulder impingement, high blood pressure, diabetes,thyroid issues etc.)
Yes
No
If yes, please describe in detail (what, when, any limitations, or doctors advice):
Are you currently taking any supplements and/or medications?
Yes
No
If Yes, list them:
Any food allergies or intolerances? (e.g. dairy, gluten, nuts)
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How would you describe your eating habits?
Very healthy
Mostly healthy
Average
Not great
Poor
How many meals and snacks do typically eat per day?
List any foods you don’t like:
How much time do you have for meal prep per week?
1-2 hours
3-4 hours
5+
None
What is your biggest nutritional challenge right now? (e.g. emotional eating, busy schedule, cravings, etc.)
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How long have you been consistently training?
None
Less than 6 months
6-24 months
1-2 years
2+ years
What type of training do you enjoy or prefer? (check all that appy)
Strength training(weights)
Calisthenics(body weight movements)
Cardio (running/cycling(
HIIT
Yoga/mobility
Other
Do you have access to: (check all that apply)
Full gym
Home gym
No equipment
Outdoor space
Any exercise(s) you absolutely hate doing?
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What motivates you to reach your goal?
What has held you back from achieving your goals in the past?
How do you order to communicate? (voice notes, video calls, Instagram, Facebook, phone call, etc)
I confirmed that the information provided is accurate to the best of my knowledge. I understand that online coaching is not a substitute for medical advice, and I take full responsibility for my health and safety.
Submit
Submit
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