JAY VELAZQUEZ FIT
ONLINE COACHING/PLANS
Full Name
*
First Name
Last Name
Age
*
years
Email
*
Confirmation Email
example@example.com
Instagram handle
*
@
When is the best time to contact you?
*
Morning
Afternoon
Evening
Other
Which of the following are you looking for?
1:1 Coaching (Includes weekly check-ins and adjustments)
Nutrition guidance
Personalized Workout Plan (Does not include check-ins or adjustments)
All of The Above
Goals
Which of the following best fits in with your goals for your training (select all that apply)?
*
Endurance
Build Muscle
Muscular Strength/Power
Weight Loss
Weight Gain
Lose Body Fat
Other
What are the top three goals you want to accomplish, in order of importance?
*
What possible personal barriers do you feel are keeping you from reaching your nutritional and fitness goals?
*
Lack of motivation
Time
Self Conscious
Lack of equipment
Lack of Results
Hitting A Plateau
Not knowing where/how to begin
Other
Training and Exercise History
What do you consider yourself?
Beginner
Intermediate
Advanced
Other
How often are you willing to train per week to reach goals?
*
Please Select
1-2
2-3
3-4
4-5
5-6
6-7
7+
Do you currently exercise on a regular basis?
*
Yes
No
If yes, how many days a week?
Have you trained with a personal trainer before?
*
Yes
No
If yes, was your previous experience negative or positive? Why?
Describe what you expect of me as your fitness coach.
*
Mental Readiness/Personality
Please rate your mental readiness to make changes to reach your goal.
*
I am not ready to make any changes.
1
2
3
4
5
6
7
8
9
I'm ready to make any lifestyle changes to reach my goals!
10
1 is I am not ready to make any changes. , 10 is I'm ready to make any lifestyle changes to reach my goals!
Please rate your motivational level to do what it takes to reach your goal.
*
I have no motivation to change my life.
1
2
3
4
5
6
7
8
9
I'm ready to make any lifestyle changes to reach my goals!
10
1 is I have no motivation to change my life., 10 is I'm ready to make any lifestyle changes to reach my goals!
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