PREMIUM ONLINE COACHING THANK YOU FOR SIGNING UP!PLEASE FILL OUT THE INTAKE FORM WITH AS MUCH DETAIL AS POSSIBLE.WE WILL BE IN CONTACT ASAP ONCE COMPLETED TO GO THROUGH YOUR INTAKE AND GET YOU STARTED. PERSONAL INFORMATION: Name * First Name Last Name Email * Phone * (###) ### #### DATE OF BIRTH * Address Address 1 Address 2 City State/Province Zip/Postal Code Country GENERAL INFORMATION: DO YOU HAVE A GYM MEMBERSHIP/ WHAT GYM IS IT? HOW MANY DAYS PER WEEK CAN YOU COMMIT TO TRAINING AND FOR HOW LONG EACH SESSION? WHAT ARE YOUR HOBBIES AND INTERESTS/ WHAT DO YOU DO TO HAVE FUN? WHAT IS YOUR IDEAL APPROACH TO 'GETTING IN SHAPE'? WHAT DO YOU FEEL YO NEED TO DO TO RESHAPE YOUR BODY AND IMPROVE YOUR HEALTH AND FITNESS? HAVE YHOU MADE ANY CHANGES TO YOUR HEALTH AND FITNESS RECENTLY? IF SO, WHAT? AND IF NOT, WHAT HAS BEEN HOLDING YOU BACK? WHAT ARE YOU LOOKING TO ULTIMATELY ACHIEVE FROM COACHING? EXAMPLE: STRENGTH, FAT LOSS, GENERAL FITNESS, NUTRITION ADVICE ETC TRAINING HISTORY: What is your athletic background? Do you currently play any sports or do any physical activity? Have you previously played sports competitively? Have you previously received coaching/ had a training program? If so please provide more information What was your experience like? Describe your current training program Is it resistance training/ aerobic training/ sports specific? How often do you train? Example of sets and reps What kind of exercises are you performing? Feel free to EMAIL/DM AN EXAMPLE/EXISTING PROGRAM AT THE CONTACT LINKS ON THIS PAGE. Please list in order of priority the training goals you would like to achieve in the next 3-12 months. Example: Gain muscle, lose fat, get stronger, improve athletic performance, have more energy, look/feel better, control eating habits, get ready for a competition etc Do you perform any aerobic training/cardio of any sort? Example: Runs, leisurely walks, swimming, biking, sports etc. FOR POWERLIFTING/STRENGTH SPECIFIC CLIENTS: Have you competed before? If so how many times and what federations? What are your short and long term strength goals? What is your best squat/ bench/ deadlift and total? High bar or low bar squatter? Conventional or sumo deadlifter? Do you have access to all competition equipment required for your federation? When is your next planned competition? What are you weak/ sticking points in each of the main lifts? LIFESTYLE: What does a typical day look like for you? List both during the week and weekends What are the current stressors in your life? What are the biggest 3 and are they avoidable? Is there anything that could prevent you from reaching your goals? Example: Any barriers; distance from the gym, working late hours, friends, children, upcoming vacations? How much sleep do you get on average and how is the quality of your sleep? Given all the demands of your life, what is your typical stress level on an average day from 1-10 (work, school, caregiving, housework, travel)? DIET/ NUTRITION AND GENERAL HEALTH PRACTICES: Right now, are you following any particular diet or style of eating? Example: Vegetarian/vegan, Paleo, Kosher/Halal, Low-carb/Keto. If yes, for how long? Please describe your current nutritional habits. If possible, include total calories, carbs, protein and fats. If unknown list a typical day eating for you. Are you currently dieting, or have you ever dieted for an extended period of time? How long was it? How much weight did you lose? What did you experience during, and after the weight loss? Do you measure how much water you drink each day? If so how much? List what supplements you take or have taken Do you smoke and, or drink? If so, how frequently? MEDICAL HISTORY: Do you currently have any injuries or existing injuries that still cause discomfort? Have you had any previous serious injuries? Do you have any medical conditions, allergies or suffered any incidents I should know about (asthma, high blood pressure, diabetes, pains, surgeries etc.)? Have you previously or are you currently taking any peformance enhancing drugs? Do you receive regular bloodwork? Please list any and all other concerns about your health, eating habits, fitness, and/or body. DISCLAIMER: Please recognise that it is your responsibility to work directly with your health care provider before, during, and after seeking nutrition and/ or fitness consultation. Any information provided is not to be followed without prior approval of your doctor. If you choose to use this information without such approval, you agree to accept full responsibility for your decision. Please type your full name below to confirm that all information provided is true and accurate and to confirm acceptance of the above. SIGNATURE THANK YOU!WE WILL BE IN TOUCH SHORTLY TO GET YOU STARTED!
