Annie Cooper Personal Training Questionnaire

Coaching Questionnaire
Part 1. Basic information
Full Name*

First NameLast Name
Email
example@example.com
Gender

MaleFemale
Date of Birth*

MonthDayYear
Age
Years
Height
Feet/Inch
Weight
Lbs
Please attach front, back, & side starting images.

Browse Files

Cancelof
Part 2. Lifestyle Information
What do you do for a living?
Whats the activity level at your job?

none(seated only)Moderate (light activity such as walking)High (heavy labor, very active)
Do you follow a regular working schedule, do you work days, afternoon or nights?
How often do you travel?

RarelyA few times a yearA few times a monthWeekly
How much sleep do you get?
Part 3. Medical and health information
If you have any diagnosed health problems list the condition(s).
If you are on any medications, please list them.
If you have any injuries, please list them.
Your current diet could be best characterized as:

low-fatlow-carbhigh-proteinVegetarian/VeganNo special diet
Where do you grocery shop?
Please list some of your favorite meals and any foods you do not like or will not eat (i.e. raw fish, onions, eggs, almond butter, etc.)
What did you eat yesterday? Give me an example of a full day of eating (drinks included!)
Are there any foods that bloat you or do not digest well with you? If so, please list them.
Are you hungry often within the day?

YesRarelyNo
Part 4. Goals
Please rate your readiness for change.

12345678910
What following goals does best fit in with your goals?

Improved healthImproved enduranceIncreased strengthIncreased muscle massFat loss
Please elaborate on your goals.

TImeline for achieving your goal.

Rows	8 WKS	16 WKS	24 WKS	32 WKS	40 WKS	1 YEAR
NOW

Are you currently excersising regulary (at least 3x per week)?

YesNo
What time of the day do you typically workout?

MorningMid-DayAfternoonEvening
What are your expectations on me as your coach?
Have you experienced eating disorders in the past? If so, give me a brief explanation of what you struggled with.
What method do you prefer for us to check in with each other each week?

FacetimePhone callTextEmail
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Please Read The Following T&C's.
*Does not apply to Online Clients*

1.) CANCELLATIONS

Cancellations should be made at least 24 hours in advance of a scheduled session. Sessions cancelled less than 24 hours in advance will be charged in full to the client.

2.) LATE ARRIVALS

Each session shall be 30 min in length. Sessions will not be extended (unless time is available) due to the lateness of the client or due to interruptions caused by the client.

3.) INJURY

The client is aware of risks involved in training. As such the trainer cannot be held accountable for injuries or death resulting from it (except in cases of negligence).

3.) ALL THE INFORMATION I HAVE GIVEN IS CORRECT

All the information on this form is correct and to the best of my knowledge. I have sought and followed any necessary medical advice. I understand that all the information given will be kept confidential.
I AGREE TO THE ABOVE TERMS & CONDITIONS!*

YesNo
Should be Empty:

Coaching Questionnaire

Part 1. Basic information

Part 2. Lifestyle Information

Part 3. Medical and health information

Part 4. Goals

Please Read The Following T&C's.