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Training Programs
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New Client Custom Design Intake Form
Please enable JavaScript in your browser to complete this form.
Full Name
*
First
Last
Email Address
*
Phone Number
*
Date of Birth
*
Current Body Weight
*
Goal Body Weight
*
What is your current occupation?
*
What is your current work schedule?
*
(Days, hours, other)
What is your current family situation?
*
(Single, Married, Kids, Student, animals, other)
Are you currently following a nutrition program?
*
Choose answer
Yes
No
Sometimes
Please describe your current nutrition program.
*
Are you currently following a workout program?
*
Choose answer
Yes
No
Sometimes
Please describe your current workout routine.
*
Why do you want to hire a personal coach?
*
How long have you been working out?
*
What type of training are you interested in?
*
(Bodybuilding, Olympic weightlifting, Powerlifting, etc)
What type(s) of training have worked well for you in the past?
*
What type(s) of training have not worked well for you in the past?
*
What are your short-term goals? And why?
*
What are your long-term goals? And why?
*
Have you worked with a personal coach before?
*
Choose answer
Yes
No
Please describe your previous coaching experience(s).
*
On average how many hours do you sleep?
*
Choose answer
2-4
5-6
7-8
Not sure
Rate your sleep quality on a scale of 1-5.
*
1 = very bad | 5 = very good
What time do you usually fall asleep?
*
How often do you wake up during the night?
*
Briefly describe your daily energy levels.
*
Rate your stress level on a scale of 1-5.
*
1 = no stress | 5 = very stressed
Describe what success looks like at the end of this coaching program?
*
Do you have any known allergies to medications, food, or the environment?
*
Are you taking any over the counter nutritional supplements?
*
(Protein powder, vitamins, minerals, probiotics, etc)
Are you taking any prescribed medications?
*
Do you have any pre-existing injuries or limitations?
*
Choose answer
Yes
No
In detail, please describe your injuries and limitations.
*
Would you like to provide any additional information?
*
SUBMIT
Please enable JavaScript in your browser to complete this form.
Full Name
*
First
Last
Email Address
*
Phone Number
*
Date of Birth
*
Current Body Weight
*
Goal Body Weight
*
What is your current occupation?
*
What is your current work schedule?
*
(Days, hours, other)
What is your current family situation?
*
(Single, Married, Kids, Student, animals, other)
Are you currently following a nutrition program?
*
Choose answer
Yes
No
Sometimes
Please describe your current nutrition program.
*
Are you currently following a workout program?
*
Choose answer
Yes
No
Sometimes
Please describe your current workout routine.
*
Why do you want to hire a personal coach?
*
How long have you been working out?
*
What type of training are you interested in?
*
(Bodybuilding, Olympic weightlifting, Powerlifting, etc)
What type(s) of training have worked well for you in the past?
*
What type(s) of training have not worked well for you in the past?
*
What are your short-term goals? And why?
*
What are your long-term goals? And why?
*
Have you worked with a personal coach before?
*
Choose answer
Yes
No
Please describe your previous coaching experience(s).
*
On average how many hours do you sleep?
*
Choose answer
2-4
5-6
7-8
Not sure
Rate your sleep quality on a scale of 1-5.
*
1 = very bad | 5 = very good
What time do you usually fall asleep?
*
How often do you wake up during the night?
*
Briefly describe your daily energy levels.
*
Rate your stress level on a scale of 1-5.
*
1 = no stress | 5 = very stressed
Describe what success looks like at the end of this coaching program?
*
Do you have any known allergies to medications, food, or the environment?
*
Are you taking any over the counter nutritional supplements?
*
(Protein powder, vitamins, minerals, probiotics, etc)
Are you taking any prescribed medications?
*
Do you have any pre-existing injuries or limitations?
*
Choose answer
Yes
No
In detail, please describe your injuries and limitations.
*
Would you like to provide any additional information?
*
SUBMIT