Full Name *

Date of birth *

Gender *

Phone *

Email *

Instagram *

Address *

Postal code *

Country *

Occupation *

Height (cm) *

Current Weight (kg) *

Bodyfat percentage (if known) *

What is your main reason for needing coaching? (Select all that apply) *

I need support and accountability from an expert coach.

I need somebody to hold me to a higher standard than I hold myself.

I have tried in the past on my own and didn't make the progress I would like.

I don't know how to achieve my goals on my own.

I need education so I can not only get the result I want but keep them for life.

What Are Your Personal Health And Fitness Goals Over The Next 6 Months? *

Why do you want to achieve this goal? *

How Do You Think It'll Impact Your Life When You Achieve This Particular Goal? *

What Are The Main Challenges That May Stop You From Achieving What You Set Out? *

Do you have any planned social events coming up in the next 3 months that may affect your transformation? *

Yes

How would you describe your ability to weight train? *

Beginner

Intermediate

Advanced

How many days per week can you commit to train? *

Do you have a gym membership, or are you willing to get one? *

YES

I have plenty of equipment at home

Do you own any Heart Rate, Sleep, or Activity tracker? *

How much water do you drink per day? *

Do you consume alcohol? *

Yes

If you responded yes to the previous question, please give me an insight into your relationship with alcohol (how regularly you drink, how much you drink, and how you feel it impacts your week and your life in general.) *

What is your average sleep duration? *

Less thank 6 hours per night

Between 6-7 hours most nights

Between 8-9 hours most nights

More than 9 hours most nights

How would you describe your sleep habits? *

Trouble falling asleep

Trouble staying asleep

No trouble falling asleep

No trouble staying asleep

How would you describe your morning energy? *

How would you rate your daily energy levels *

Low

Average

High

Do you struggle or suffer with any of the following: *

Fatigue/sluggishness

Lethargy

Restlessness

None of the above

Do you consume caffeine after 3pm? *

Yes

Are you exposed to blue light after 8pm? (phone, laptop, TV) *

Yes

Do you experience any of the following (body aches): *

Please List All Current Medication And Reason For That Medication. *

Please List All Current Supplements And Reason For Those Supplements. *

Please List All Current/Prior Injuries *

Please List All Prior Surgeries *

(Female only) Do you currently take contraception medication?

Yes

(Female only) is you period regular?

Yes

Please List Any Food Intolerances *

Do you have any digestive issues?

Yes

If you responded yes to the previous question, please explain as detailed as possible.

How would you rate your daily hunger/ appetite *

I am overfull after all my meals

I am satisfied after my meals

I am hungry after/in between meals

How many calories do you eat per day if known? *

How many steps do you do per day if known? *

You confirm that you have completed this questionnaire based on your current health profile on the date stated above and provided all of the information necessary in order to undertake a training and structured nutrition program. *

I agree

Signature *

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