Unrestrained Fitness Programming Client Questionnaire

1

Full Name* This field is required.

First Name

Last Name

2

Age* This field is required.

3

Date of Birth* This field is required.

Date

4

Height

5

Current Weight

6

Occupation

7

Email Address* This field is required.

example@example.com

8

Phone Number* This field is required.

Please enter a valid phone number.

10

Rank your top 3 goals* This field is required.

11

What would success look like in 3 months?

12

What would success look like in 12 months?

13

How long have you been strength training?

14

Describe your current workout routine

15

Have you followed a structured program? If yes, which?

16

What exercises do you enjoy?

17

What exercises do you dislike?

18

Bench Press (current strength level)

19

Squat (current strength level)

20

Deadlift (current strength level)

21

Overhead Press (current strength level)

22

Pull-ups (current strength level)

23

Other (strength level)

25

If Other equipment, please specify

26

Training days per week* This field is required.

27

Preferred workout length

28

Unavailable days

29

Current calorie intake

30

Do you track food? If yes, which app do you use?

31

Protein intake

32

Water intake

33

Meals per day

34

Food allergies

35

Foods you avoid

36

Favorite foods

37

Do you cook?

38

How often do you eat out?

39

Hours of sleep

42

Occupation activity level

43

Average daily steps

44

Current cardio routine

45

Willing to perform cardio?

46

Preferred cardio

47

Physician Cleared?* This field is required.

48

Current Injuries

49

Past Surgeries

50

Medical Conditions

51

Current Medications

52

Pain While Exercising?* This field is required.

54

If Other Supplements, Please Specify

55

Typical Soreness

56

Recovery Methods

59

What causes you to fall off track?

60

Preferred coaching style

62

Preferred contact method

63

Preferred check-in day

64

Expected coach response time

65

What has prevented success in the past?

66

Biggest concern

67

Anything else your coach should know

68

Agreement acknowledgment* This field is required.

I understand and agree to follow the coaching expectations and responsibilities outlined by my coach.

69

Client Signature* This field is required.

70

Date* This field is required.

Date