P3 Client Questionnaire
Name
*
Phone number
*
E-mail
*
example@example.com
Date of Birth
*
Height
*
Weight
*
Age
*
What are you looking for help with?
*
Nutrition
Online Coaching
Workout Split- periodization
Corrective Exercise
Contest Prep
Personal Training
Posing
Small Group Training
How did you find out about P3?
What is your occupation?
Goals
Please Select the one that best describes your goals:
*
FAT/WEIGHT LOSS= Designed to decrease body fat while preserving lean body mass.
MAINTAIN WEIGHT/CHANGE BODY COMPOSITION= Designed to maintain current body weight and develop muscle density.
WEIGHT GAIN= Designed to increase lean body mass (muscle) with a minimal increase in body fat.
STRENGTH GAIN= Designed to improve physical strength
REDUCE PAIN/INCREASE MOVEMENT= Designed to improve physical movement and/or reduce pain.
Why have you chosen to hire a Health & Fitness Practitioner?
What are some obstacles (behaviors, stress, activities, etc) that you foresee impeding your success? Have you developed any plans to overcome these obstacles?
Lifestyle
What best describes your professional activity level?
*
SEDENTARY= Sitting more than 7-8 hours during the work day.
MODERATELY ACTIVE= Sitting 6 hours and on your feet at least 2 hours during a work day.
ACTIVE= On your feet more than 5 hours during the work day.
VERY ACTIVE= On your feet more than 6 hours and doing periodic lifting during the work day.
Have you had recent blood work done?
Do you have any allergies you are aware of?
If you are on any medications, please list them.
Nutritional Information
How do you monitor your eating habits?
Do you feel that you eat a healthy diet most of the time?
How much water do you drink per day?
Do you consume coffee?
Energy Drinks?
Do you consume alcohol?
Describe a typical day in your diet from waking until bed:
How do you feel about diets? Have you tried and "fad" diets?
Do you take supplements? If yes, please list below:
Do you have any specific cravings? If yes, for what and when?
How much sleep do you typically get?
What time do you normally wake?
When do you usually consume your first meal for the day?
Do you struggle with structure?
Any prior eating disorders or a form of disordered eating? If yes, please describe.
Fitness
Do you train or do cardio on an empty stomach?
Have you been exercising consistly for 3 months?
How long have you been exercising?
When were you in your best shape?
When did you decide to get in shape?
Have you begun an exercise program in the past?
Were you successful?
What if anything stopped you from continuing?
What is different this time?
Current Program/Program Development
Weight Training?
Yes
No
Duration:
Frequency:
Cardiovascular?
Yes
No
Duration:
Frequency:
Realistically, how often are you willing to exercise?
How long are you willing to spend at each exercise session?
List any other cardio/sports/activities that you are involved in:
Current Health and Wellness
Any specific area that you are dealing with pain?
If so, how long have you been managing it?
Do you have any injuries or past surgeries? Please list any details, even if you think they may not be important.
Are there any specific exercises that you are unable to perform? Please list:
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