Coaching Application Form

Progression Health Coaching | Consultation Questionnaire
About You
Full Name

First NameLast Name
Gender
Date of Birth

MonthDayYear
Age
Years
Height
CM / Feet
Weight
KG/LB
Lifestyle Information
What physical activities, sports, or exercise do you currently do outside of structured gym sessions?
If relevant, list any recent performance benchmarks you know, such as strength numbers, recent race times, weekly mileage, or other useful training metrics.
How would you describe your current stress level, and what are the main sources of stress in your life?
How much do you want to understand the reasoning behind your training plan?
Please list any current concerns about your health, fitness, nutrition, or body composition.
Of everything you listed, what is the single highest priority for you right now?
How much do you want to understand the reasoning behind your training plan?
Have you previously worked with a personal trainer or online coach?
If you have worked with a trainer or coach before, what worked well and what would you want to improve?
What is your exercise or sports background? Include anything relevant from childhood through the present.
Medical and health information
Do you currently have any diagnosed health conditions?
Are you currently taking any medications or supplements?
Do you have any major or chronic injuries, surgeries, or physical limitations we should know about?
Do you have any medical conditions such as diabetes, asthma, or high or low blood pressure?
Do you currently smoke cigarettes?
Do you currently have any pain, symptoms, physical limitations, or medical concerns that may affect exercise? If yes, please explain.
Has a medical professional advised you to restrict or modify exercise? If yes, please explain.
Do you drink alcohol? If yes, approximately how often?
What is most likely to get in the way of consistency?
How many times/month?
Goals
On a scale of 1 to 10, how confident are you that you can consistently follow a realistic training plan over the next 8 to 12 weeks?
What would make the next 3 to 6 months of coaching feel successful to you?
Client Declaration
What type of coaching are you interested in?
How did you hear about Progression Health Coaching?
Where are you based? If you are outside the West Coast of the US Pacific time zone, please include your time zone.
Please review the following declaration carefully: - The information provided is accurate to the best of my knowledge. - I will disclose relevant health changes as they occur. - Coaching is not a substitute for medical diagnosis, treatment, or advice. - I will seek appropriate medical guidance when needed. - My information will be handled confidentially within normal business and legal requirements.
I have read and agree to the Client Declaration above.
Phone Number

Area CodePhone Number
Email
example@example.com
Appointment
Should be Empty:

Progression Health Coaching | Consultation Questionnaire

About You

Lifestyle Information

Medical and health information

Goals

Client Declaration