Onboarding Form

Train With Emma Jane

Onboarding Form
Name*

First NameLast Name
Pronouns
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Birth Date*

MonthDayYear
Weight in lbs*
LBS
Height in cm or feet*
cm
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Occupation (this includes studying, stay at home parenting, part time, etc.)*
Are you currently pregnant or breastfeeding?

NoPregnantBreastfeedingPregnant & Breastfeeding
Do you have any diagnosed health conditions? (Ex. Arthritis, Heart Disease, Obesity, Depression, PCOS, Endometriosis, etc.)
Are you taking any medications? If yes, please list below.
Do you have any current or past injuries? If yes, please list below.
What is your weekly budget?*

$75-$99$100-$199$200+
What does your current nutrition look like? Select all that apply.*

Low-fatLow-carbHigh-proteinVegetarian/VeganKetoPaleoGluten-FreeNo Specific Diet
Do you smoke cigarettes?*

YesNo
How many alcoholic beverages do you consume in a week?*

I do not consume alcohol1-23-45+
What is your daily activity level?*

1

2

3

4

5

1 is None, 5 is Highly Active
What is your daily stress level?*

1

2

3

4

5

1 is Low, 5 is High
How many hours of sleep do you get on average?*

5

6

7

8

9

5 is Low, 9 is Good
Which of the following statements fit in with your goals? Select all that apply.*

Manage Chronic ConditionIncreased MobilityIncrease StrengthImproved Mental HealthNutrition PlanStress ManagementFat Loss
What days of the week are you available to train?*

MondaysTuesdaysWednesdaysThursdaysFridaysSaturdays
Please rate your readiness to change.*

1

2

3

4

5

1 is Not ready , 5 is WOO!
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Train With Emma Jane