D1 Dad Workout Program Intake

Full name* This field is required.

First Name

Last Name

Email address* This field is required.

example@example.com

Age* This field is required.

Height in feet and inches

Current weight in pounds

Enter your weight in pounds

Primary goal* This field is required.

Fat loss

Build muscle

Maintain and perform

Longevity and stay healthy

Get out of pain

What does success look like 8 weeks from now?* This field is required.

Why now and why is this the moment?

Years of consistent strength training

Less than 1

1 to 3

3 to 5

5 to 10

10 plus

Self-rated training level* This field is required.

Beginner

Intermediate

Advanced

Athletic background

What sport did you play, and at what level?

When was your last consistent 8 week training cycle

Currently training

Within the last 3 months

3 to 12 months ago

Over a year ago

Never had one

Current training days per week

1 to 2

6 plus

Where do you train most often?* This field is required.

Commercial gym

Home gym

Garage gym

Mix of locations

Other

If you train at home or garage, check all equipment you have access to.

Barbell

Squat rack

Dumbbells

Kettlebells

Resistance bands

Bench

Pull up bar

Cable machine

Rower

Assault bike or stationary bike

Ski erg

Sled

Battle ropes

Plyo box

Outdoor space for sprinting or carrying

How often do you travel for work or family?

Never

1 to 3 times per month

Weekly

Always on the road

How many days per week can you realistically train?* This field is required.

How many minutes per session can you commit to?* This field is required.

75 or more

Preferred time of day to train

Early morning before kids

Mid morning

Lunch

Afternoon

Evening after kids

Days that are off limits

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Average sleep per night in hours

4 to 5

5 to 6

6 to 7

7 to 8

8 plus

Stress level right now on a scale from 1 to 10

List any current injuries or chronic pain. Be specific about location and what makes it worse.* This field is required.

Joints that get cranky on you. Check all that apply.

Knee

Hip

Low back

Shoulder

Neck

Ankle

Wrist

Elbow

None of the above

Movements you actively avoid.

Running

Overhead pressing

Deep squats below parallel

Conventional deadlift

Jumping or plyometrics

Burpees

None of the above

Have you been cleared by a doctor to train* This field is required.

Yes

Not sure but I have no reason not to be

Cardio preference. What do you actually enjoy.

Running

Rowing

Biking

Sled pushes

Kettlebell flows

CrossFit style metcons

I would rather not do dedicated cardio

Movements you LOVE and want more of

Movements you HATE

Do you currently track macros or calories?

Yes consistently

On and off

Estimated average daily calories

Diet style

Standard mixed diet

High protein focused

Low carb or keto

Vegetarian

Vegan

Other

Allergies or food restrictions

Average alcoholic drinks per week

Biggest nutrition challenge

How many kids do you have?

Job type

Marriage or partner status

Married

In a long term relationship

Single

Other

Is your partner training too or interested in training?

Yes already training

Yes interested but no plan yet

Not applicable

Biggest life obstacle to staying consistent with training

On a scale of 1 to 10, how committed are you right now?* This field is required.

Have you tried online programs before. What worked or did not work?

What is your single biggest fear or hesitation about starting this?

Your playbook is in motion. We will review your intake within 24 hours and your program will be built specifically for you. Welcome to the team.

- Coach Mike, Dad of 3 & Founder of D1 Dad.