Online Coaching Evaluation

1
Full Name* This field is required.
First Name
Last Name
2
Gender* This field is required.
Male
Female
3
Date of Birth* This field is required.
Month
Day
Year
4
Age* This field is required.
years
5
Height (ft)* This field is required.
6
Weight (lbs)* This field is required.
7
Phone Number* This field is required.
8
Email* This field is required.
example@example.com
9
How do you prefer to be contacted?* This field is required.
Please Select
Please Select
Phone (Text)
Phone (Call)
Email
10
What do you do for a living?
11
What is the activity level at your job?
None (seated only)
Moderate (light activity such as walking)
High (heavy labor, very active)
12
Do you follow a regular work schedule? If not, please describe your work schedule.(If you work nights, evenings, early mornings, etc.)
13
Please list any physical activities that you participate in outside of the gym and work:
14
Do you suffer from diabetes, asthma, high or low blood pressure?* This field is required.
Yes
No
15
If you have any diagnosed health problems list the condition(s).* This field is required.
16
If you have any injuries, please list them.* This field is required.
17
Are you experiencing any stresses or motivational problems?* This field is required.
Yes
No
18
If yes, please explain:
19
Are you a current smoker?* This field is required.
Yes
No
20
Please rate your readiness for change.
1
2
3
4
5
6
7
8
9
10
21
Which of the following goals best fits in with your goals?* This field is required.(pick all that apply)
Improve Health
Tone Up
Increase Strength
Increase Muscle Mass
Fat Loss
Weight Gain
Build Gym Confidence
Build My Gym Knowledge
Change My Lifestyle
Improve My Energy Level
22
What area(s) do you want to focus on most?* This field is required.(Insecurities)
23
What is your goal with your training?* This field is required.
24
Why do you want to change your lifestyle? (What is YOUR motivation to want change)* This field is required.
25
Timeline for achieving your goal.
12 WKS
24 WKS
32 WKS
40 WKS
1 YEAR
NOW
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Row 0, Column 4
NOW
12 WKS
Row 0, Column 0
24 WKS
Row 0, Column 1
32 WKS
Row 0, Column 2
40 WKS
Row 0, Column 3
1 YEAR
Row 0, Column 4
26
Are you currently exercising?
Yes
No
27
Have you trained with a personal trainer/ online coach before?* This field is required.
Yes
No
28
If yes, why did that coaching not work for you?* This field is required.
29
At what times during the day would you prefer to train?
Morning
Mid-Day
Afternoon
Evening
30
How often do you want to train per week?* This field is required.
Please Select
Please Select
3x per week
4x per week
5x per week
6x per week
Please Choose
31
Are you okay with Progress Photos and Video Form Checks (this will be a must with online coaching)?* This field is required.
Yes
No
32
Is it okay to post Progress Photos and Form Videos to social media of training?* This field is required.
Yes
No
Only photos/ videos I approve of
33
What are your expectations of me as your Personal Trainer?* This field is required.
34
1.) CANCELLATIONS: (Online Coaching) There is a 6 month minimum. The client can not cancel coaching until the contract is fulfilled.

2.) CANCELLATIONS: (In-Person Sessions) Cancellations should be made at least 24 hours in advance of a scheduled session. Sessions cancelled less than 24 hours in advance will not receive a refund for the session.

3.) LATE ARRIVALS: Each session will be either 30 Minutes or 1 Hour Durations. Sessions will not be extended (unless time is available) due to the lateness of the client or due to interruptions caused by the client.

4.) CONFIDENTIALITY: I understand that all the medical information given will be kept confidential. Any/ all information discussed between the coach and client will be kept confidential.

5.) FORM INFORMATION: All of the information on this form is correct and to the best of my knowledge. I have sought and followed any necessary medical advice, and given every need to know detail moving forward.

6.) CLIENT DROP: If the client cancels more than 1 time per month (In-Person sessions), does not communicate, or does not follow program and nutrition advice, coaching will be terminated.
35
I HAVE READ & AGREE TO THE ABOVE TERMS & CONDITIONS!* This field is required.(signature)
Clear
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