Name
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First Name
Last Name
Email Address
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Instagram Handle
Age
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Height
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Current weight
Gender
Female
Male
Other
Training (be as specific as possible)
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Frequency (# of days per week you currently weight train)
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None
One
Two
Three
Four
Five
Six
Seven
Type of training
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Duration (on average) per training session
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How long have you been training CONSISTENTLY
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How many days a week can you commit to fitness?
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Two
Three
Four
Five
Six
Describe what your average daily nutrition routine looks like
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Food preferences
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Are you losing, maintaining, or gaining weight currently?
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Describe your dieting history
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Please provide a detailed list of any existing and/or pre-existing food allergies, food intolerances, nutrient deficiencies, diseases, etc
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Ex: lactose intolerance, peanut allergy, anemia, Celiac’s disease
Have you ever or are you currently dealing with any sort of eating disorder such as anorexia nervosa, bulimia nervosa, or binge eating disorder (BED)?
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If yes, I am unable to work with you as that’s outside of my scope of practice. I am happy to provide you with resources if you wish!
Do you have any other serious medical or psychological disorder/disease?
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Please provide details, including but not limited to age of diagnosis, medications you’re on, necessary lifestyle modifications as a result of your disease, etc.
If you had to list them, what would you say your top five priorities in your life currently are?
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Personal goals
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Please provide 3-5 body-related goals and 3 non-body related goals.
Physical (add mass, reduce body fat, etc)
Non-physical (strength related goals, mental goals, etc)
How long are you looking to work with a coach?
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What is your reasoning for wanting to work with me as your coach?
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What is the biggest thing that has held you back in your journey?
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What are you motivated by?
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What is most discouraging to you?
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How did you get to where you are now with regards to your fitness and health (for better or for worse)?
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What are your biggest strengths?
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(does not have to be fitness related)
What are your biggest weaknesses?
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(does not have to be fitness related)
