Initial Diagnostic V2

1

Consent to Process Sensitive Performance Data* This field is required.I provide my explicit, affirmative consent for Blueprint Athletic Coaching to collect and process my sensitive personal data, including physical health information and biometric markers. I understand that: Purpose: This data is used solely to generate my bespoke Athletic Blueprint and to match me with a vetted performance coach. Privacy: My data will not be sold, shared for cross-context behavioral advertising, or used for any purpose other than my direct performance coaching. Control: I have the right to withdraw this consent and request the deletion of my physiological profile at any time.

I provide my affirmative consent to the processing of my sensitive health data as described above.

2

I have read and agree to the Safety Clearance and Liability Waiver. I thoroughly understand the risks involved and understand that Blueprint Athletic Coaching is not liable for any incident resulting from the use of our services.* This field is required.

I understand

3

Name* This field is required.

First Name

Last Name

4

Email* This field is required.

example@example.com

5

Phone Number

Area Code

Phone Number

6

What area are you seeking assistance in?* This field is required.

Personal Training

Nutrition Coaching

Mindset Strengthening

Not sure

7

Have you ever had a performance coach in the past?

YESNO

8

In a few of your own words, please explain what you would like the Blueprint Athletic Coaching team to help you with?* This field is required.

9

How would you best describe your current activity level?* This field is required.These choices are very broad and are meant to be generic. More specific questions to come!

I do not currently participate in any physical activity

I do light movements, such as walking

I do moderate physical activity, such as strength training or running, at least 2x per week

I do moderate solo training sessions or group classes about 3-4x per week

I am in the gym or training in some way with moderate to high intensity about 5x per week

10

How would you describe your resistance training goals?* This field is required.Choose all that apply

I want to train with weights for general strength and health

I want to use resistance training as a means for increased fat loss

I want to focus on mobility and longevity through functional movements

I want to do circuits/HIIT for a faster paced workout

I want to train movements specific to my sport

I want to build muscle and improve my physique

I want to focus on getting stronger and lifting heavier

I am not sure what I want

11

How would you best describe your experience with resistance training?* This field is required.

I am brand new to lifting weights and have never done so in the past

I have lifted weights previously but am not currently doing so

I currently lift weights 2-3x per week

I currently lift weights at least 4x per week

I am currently doing/have done sport specific resistance training

I am an experienced lifter looking to continue enhancing performance

12

How would you describe your cardio/endurance goals?* This field is required.Choose all that apply

I want to increase my daily movement for general health

I want to supplement my resistance training with light movements

I want to add/build cardio for increased fat loss

I want to do circuit/HIIT workouts for a blend of strength and cardio

I want specific endurance workouts for things like running, biking, etc.

I want to increase my aerobic capacity

I am not sure what I want

13

How would you best describe your experience with cardio/endurance training?* This field is required.

I do very light intensity cardio, such as steady walking

I do light/moderate intensity cardio, such as steady running or biking

I do high intensity cardio, such as high intensity interval training or sprints

I do high intensity endurance training, such as distance running

I do high intensity endurance training sessions, specific to my sport

I currently do not do any cardio

14

Rank your overall intensity when doing any kind of structured exercise.* This field is required.

Minimal intensity

Low intensity

Moderate intensity

High intensity

Very high intensity

15

Have you ever had any kind of nutrition coaching previously? This could be from a nutrition coach, dietician, nutritionist, etc.

YESNO

16

How would you describe your nutritional goals?* This field is required.Choose all that apply

I want advise in general nutrition concepts to make smarter dietary choices

I want advise in balancing food for body composition (gain/lose weight)

I want to increase nutrient profile to help with health and longevity

I am interested in learning about different diets to see how they could affect me

I want a performance coach to build a nutrition plan specific to my needs

I am an athlete and want to learn more about advanced nutrition concepts to increase performance

I am not sure what I want

17

How would you describe your experience with nutrition?* This field is required.

I don't really think about what I eat

I try to be conscious of what I consume

I have tried dieting in the past

I have tracked food/calories in the past

I have a decent understanding of nutrition science

I consume "fast food" 3 or more times per week

I consume "fast food" less than 3 times per week

I cook most of my own meals

18

Do you have any dietary restrictions?* This field is required.

19

Have you ever had a mental coach before, in regards to athletics or performance?* This field is required.

YESNO

20

Do you struggle with any mental blocks (i.e. lack of motivation, self-doubt, etc.) affecting training, nutrition, or performance?* This field is required.

Yes

No

Sometimes

21

If you do experience mental blocks, please briefly describe them, if you feel comfortable doing so.

22

How would you describe your mindset goals?* This field is required.Choose all that apply

I want a coach to help motivate me to get to the gym

I want to introduce visualization techniques into my gym life

I want to increase my intrinsic motivation

I want to discover more ways that movement can improve my life outside of the gym

I want to increase my confidence in and out of the gym

I want to learn which pre-performance habits (PPH's) work best for me

I am not sure what I want

23

What is your communication preference for accessing your coach?* This field is required.Choose all that apply

Email/texting/messaging

Phone calls

Facetime/Zoom

24

What communication levels are you looking to receive from your coach?* This field is required.Choose all that apply

I am not interested in much contact beyond receiving the personalized program

I want to be able to contact my coach multiple times per week for updates

I would like near 24/7 communication with my coach

I would like my coach to be available during my session so I can call for questions, form checks, etc.

I would like my coach to be ready to alter workouts on the day of, depending on how I am feeling

I want weekly meetings with my coach to review the program and make edits

I want bi-weekly or monthly meetings with my coach to review the program and make edits

I am not sure what I want

25

What type of support would you like from your coach?* This field is required.Choose all that apply

I will benefit from workout reminders

I want my coach to motivate me via text/call to help me make it to the gym

I am interested in seeing the high amounts of data used to track my progress

I prefer a more emotional approach with less science

I do well with a lot of support to keep me accountable

I tend to be mostly independent but enjoy occasional check-ins

I am not sure what I want

26

If currently doing so, what days/times do you usually workout?* This field is required.

27

How many times per week would you ideally be able to train?* This field is required.This can be total sessions, strength + cardio

1-2 times per week

3-4 times per week

5-6 times per week

Not sure

28

What days/times would you be available for a consultation?* This field is required.