Performance Evaluation
Complete this performance evaluation so the form mirrors the attached document’s sections, questions, scoring, and conditional follow-up logic.
Client Information
Full Name
*
First Name
Middle Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Height
Weight
Occupation
Primary Exercise Location
Home
Gym
Outdoor
Other
Equipment Access
Days per Week Realistically Available for Exercise/Coaching
What are you looking for?
Fat Loss
Muscle Gain
Strength
Improved Fitness
Better Energy
Accountability
Other
Goals & Motivation
Primary outcome / ONE outcome that matters most right now
*
What is currently getting in the way
Time constraints
Lack of consistency
Low energy
Pain or discomfort
Stress
Poor sleep
Nutrition challenges
Lack of clear plan
Motivation
Other
Why accomplishing this is important
*
What have you already tried
What would be different 3–6 months from now if successful
*
Scored Pillars: Health, Movement, Nutrition, Recovery, Performance
H1. How would you rate your current overall health?
*
Please Select
0
1
2
3
4
H2. How often do you experience illness or minor health issues that affect training?
*
Please Select
0
1
2
3
4
H3. How consistently do you manage stress and maintain balanced energy levels?
*
Please Select
0
1
2
3
4
H4. How well do you recover from physical or mental strain?
*
Please Select
0
1
2
3
4
H5. How would you rate your overall health habits and self-care?
*
Please Select
0
1
2
3
4
M1. How would you rate your current movement quality and mobility?
*
Please Select
0
1
2
3
4
M2. How well do you move through fundamental patterns without pain or restriction?
*
Please Select
0
1
2
3
4
M3. How would you rate your coordination and body control?
*
Please Select
0
1
2
3
4
M4. How well do you maintain posture and alignment during daily activity or exercise?
*
Please Select
0
1
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4
M5. How would you rate your movement confidence and physical function?
*
Please Select
0
1
2
3
4
N1. How would you rate the quality of your overall nutrition?
*
Please Select
0
1
2
3
4
N2. How consistently do you follow a nutrition plan that supports your goals?
*
Please Select
0
1
2
3
4
N3. How would you rate your protein intake consistency?
*
Please Select
0
1
2
3
4
N4. How well do you manage hydration and daily fueling?
*
Please Select
0
1
2
3
4
N5. How would you rate your nutrition decision-making in typical day-to-day situations?
*
Please Select
0
1
2
3
4
R1. How would you rate your sleep quality?
*
Please Select
0
1
2
3
4
R2. How consistent is your sleep schedule?
*
Please Select
0
1
2
3
4
R3. How well do you recover between training sessions?
*
Please Select
0
1
2
3
4
R4. How would you rate your recovery practices (mobility, rest, downtime, etc.)?
*
Please Select
0
1
2
3
4
R5. How ready do you feel on most days to train again?
*
Please Select
0
1
2
3
4
P1. How would you rate your current overall performance level?
*
Please Select
0
1
2
3
4
P2. How well are you progressing toward your performance goals?
*
Please Select
0
1
2
3
4
P3. How would you rate your consistency in training execution?
*
Please Select
0
1
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3
4
P4. How well do you handle intensity, volume, and recovery demands?
*
Please Select
0
1
2
3
4
P5. How confident are you in your ability to perform at your best?
*
Please Select
0
1
2
3
4
Health and Exercise Screening
Do you have any current or past medical conditions we should know about?
*
No
Yes
Please describe your medical condition(s)
Have you had any injuries, surgeries, or hospitalizations in the past 5 years?
*
No
Yes
Please describe your injuries, surgeries, or hospitalizations
Do you currently take any medications that may affect exercise?
*
No
Yes
Please list the medications and any exercise considerations
Have you ever been advised by a medical professional to avoid or limit exercise?
*
No
Yes
Please explain the exercise restrictions or guidance you were given
Do you experience any of the following during exercise?
Chest pain
Dizziness
Shortness of breath
Fainting
Palpitations
None of the above
Training History and Current Program
How long have you been training consistently?
*
Less than 6 months
6–12 months
1–3 years
3–5 years
More than 5 years
Which training methods have you used regularly?
Strength training
Cardio
HIIT
Mobility/Flexibility
Sport-specific training
Group classes
Other
Describe your current training program
*
How many days per week do you currently train?
*
0–1 days
2–3 days
4–5 days
6+ days
What time of day do you usually train?
Hour Minutes
AM
PM
AM/PM Option
Where do you usually train?
*
Home
Gym
Outdoor
Studio/Facility
Mixed locations
Other
What does a typical training week look like?
How would you describe your current training intensity?
Very light
Light
Moderate
Hard
Very hard
Which areas do you currently prioritize in training?
Strength
Endurance
Mobility
Power
Body composition
Sport performance
Recovery
Other
What challenges or barriers affect your training consistency?
Path Selection and Conditional Follow-Up
Which path best fits your current focus?
*
REBUILD
TRANSFORM
PERFORM
What is the main issue you want to rebuild?
*
How would you describe your current training consistency?
*
Not consistent
Somewhat consistent
Very consistent
What does success look like for you in this rebuild phase?
What is the main outcome you want to transform?
*
What is your primary motivation for making this change?
*
Health
Appearance
Confidence
Performance
Other
What obstacles do you expect during the transformation process?
What is your current performance goal?
*
What type of performance focus do you want to prioritize?
*
Strength
Endurance
Speed
Power
Sport-specific
Other
How will you measure progress toward performance?
Is there anything else we should know about your chosen path?
*
Do you want a coach recommendation based on your selected path?
Yes
No
Optional Video / Physical Assessment Uploads
Squat Video Upload
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Hinge Video Upload
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Split Squat/Lunge Video Upload
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Push Video Upload
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Pull Video Upload
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Locomotion Video Upload
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Sprinting/Running Video Upload
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Sport-Specific Movement Video Upload
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Final Reflection and Readiness
Final open-ended reflection
*
Readiness to proceed
*
Not ready
1
2
3
4
5
6
7
8
9
Fully ready
10
1 is Not ready, 10 is Fully ready
Biggest concern or barrier
Anything else you'd like to share
Performance Evaluation Acknowledgment & Consent
*
Submit
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