Name
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First Name
Last Name
Date Of Birth
Email
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Height
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Weight (Fasted)
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Waist Circumference (Inches/Belly Button)
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What specific goal are you currently trying to achieve & why is this important to you?
Please list 2 specific short term and long term goals & why are they important to you?
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2 Short Term Goals (6-12 weeks) & why are they important to you?
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2 Long Term Goals (6-12 months) & why are they important to you?
What do you currently do for a living?
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What hours do you typically work?
How many hours sleep do you typically get each night?
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Time you usually go to bed and time you typically wake?
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How would you rate your daily stress levels on a scale of 1-5?
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Do you currently own an activity tracking device? (Fitbit, Garmin, Apple Watch.. Etc)
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If you do own an activity tracker, how many steps are you roughly achieving each day?
Are you currently using any sports/health supplements or medication?
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Any physical activity you do throughout the week? (Eg. Sports, Martial Arts, Running)
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Do you drink alcohol or use recreational drugs, if so how frequently and amount consumed/used?
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On a scale of 1-5 what would you rate your current lifestyle in relevance to your goals: (1 = Poor, 5 = Perfect)
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What part of your lifestyle do you think needs to be improved most to achieve your current goals & Why?
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What gym are you currently training at if any?
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Are you currently following a program? If so what is it?
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How many days per week do you enjoy train in the gym?
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Any specific days you don't enjoy or can't train in the gym?
What time of the day do you typically/enjoy to train in the gym?
What is your current training experience?
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Any specific exercises you'd really like to focus on?
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If there was one thing you'd like to improve with your current training what would that be?
Any previous/current injuries or concerns?
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Any specific body parts you would like to focus on more than others?
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How many meals per day do you currently eat?
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What times of the day do you typically eat your meals?
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How many times do you usually go food shopping per week? What days?
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Please list a minimum of 5 foods you enjoy and could easily consume everyday:
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Please list a minimum of 4 food combinations/meals you enjoy eating:
What do you think you currently do well with your nutrition & Why?
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What do you think needs to be improved most with your current nutrition & Why?
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Any particular foods you really dislike, don't eat or have an intolerance to?
Do you have any experience tracking your nutrition through a food logging app like MyFitnessPal?
WEEKDAY NUTRITION
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Please list below a rough recall of what your current day of eating roughly looks like Monday-Friday:
WEEKEND NUTRITION
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Please list below a rough recall of what your current day of eating roughly looks like on a Saturday-Sunday:
Why do you think you'd be a good fit for coaching?
What's the main thing(s) you think I can help you with?
Do you understand that your current habits will need to change, you will feel uncomfortable and hard work is ahead to get to where you need to be?
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If we do end up working together there will be a 12 week initial commitment period to ensure we have ample time to achieve the desired results, is this something you are prepared to commit to?
EXTRA INFO
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Please provide a detailed description of any information that may be helpful for me structuring your plan below:
(Please don’t leave this section blank, there will always be something of relevance)
For Example: Additional goals, upcoming events, concerns, past experience working towards your goals, current expectations of me as your coach.
