ONLINE COACHING FORM

1
Name
First Name
Last Name
2
Email
example@example.com
3
Phone Number
Please enter a valid phone number.
4
How old are you?
5
How tall are you (In Centimetres)
6
What is your occupation?
7
What is your current bodyweight?
8
What would you like to achieve with hiring an online coach. Please list your goals and aspirations.
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Ok
Ok
9
What is something that has prevented you from achieving these goals in the past?
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Ok
10
What does your current diet look like on a daily basis? Please be as specific as possible
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11
How often (If at all) are you training in the gym per week?
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12
What kind of training are you doing? What do you enjoy most about this type of training?
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13
What are some things in your life that cause you the most stress?
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Ok
14
Do you have any previous injuries or illnesses that have been assessed by an allied health professional?
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15
What gym are you training at if none please specify
16
Do you have any food allergies? if so please specify
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17
Are you willing to zone in and give 110% to the process of achieving your goals and aspirations with fitness?
Yes absolutely
NO
Maybe Im not sure
18
Do you have access to a smart phone for weekly check ins, and app download?
19
Signature
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