Welcome to COACH JUNIOR CONCEPT!

We’re excited to be part of your journey toward optimal fitness and health. To give you the best support possible, please take about five minutes to share some information about your health history, fitness experience, and your goals.
Thank you for choosing us—we can’t wait to work together and help you achieve amazing results!

The best time to be your best is now!

First Name

Last Name

What is your Email? *

What's the best Phone Number to reach you? *

Birthdate? *

What is your gender?

How did you hear about me ?

Personal Referral

Google/Search Engine

Thumbtack

Yelp

'Top Gyms/Trainers in SF' Listing

Other

If you found me online, great! I would love to know which keywords you used to search for us. As a growing business, this will help me market more effectively to my ideal clients.

Example: Personal Trainers, Personal Training SF, Best Trainer San Francisco, etc.

Which days would you prefer to work out with me? (I train clients between 6a-7p Monday through Friday) Saturday on request *

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

What times of day work best for your schedule? The more options, the better it will be to fit in with the coach *

6am-7am

7am-8am

8am-9am

9am-10am

10am-11am

11am-12pm

12pm-1pm

1pm-2pm

2pm-3pm

3pm-4pm

4pm-5pm

5pm-6pm

6pm-7pm

7pm-8pm

How many days per week would you like to work with a trainer? *

(One, Two, Three, etc)

Do you have any specific scheduling requests?

Example: Workout 1x week with a trainer + be given homework for an additional workout at home. Please feel free to skip if you do not have any specific requests.

Based on your background with fitness, working out + athletics, rate your experience level.

Beginner

Intermediate

Advanced

Which training style(s) do you thrive best under? *

Supportive

Direct

Energetic

Laid Back

Intellectual

Lifestyle Coach

Accountability Partner

On a scale of 1-5, how would you rate your current activity level?

1

2

3

4

5

1 being rarely active + 5 being very active.

Please select all activities you are currently involved in

Gym Membership

Virtual Workouts (ie: Peloton, Tonal, etc)

Yoga

In-person Group Fitness Classes

Daily Physical Activities (ie: Bike, Hike, Run, Walk)

Meditation

Other

On a scale of 1-5, how would you rate your current state of health + wellness?

1

2

3

4

5

1 being very unhealthy + 5 being very healthy.

Please explain your rating.

On a scale of 1-5, how would you rate your stress levels (taking into account emotional, physical, chemical well-being)?

1

2

3

4

5

1 being stress free + 5 being very

Please explain your rating.

Please rate your body coordination and movement

1

2

3

1 = I often feel *unstable *or unsure of trusting my own body 2 = I feel *competent *in my daily movement and activities 3 = I feel *advanced *and confident in my movements for daily activities and sports

Please describe your current eating habits.

Example: Daily nutrition, food allergies, Whole30, vegetarian, paleo, etc

Now, tell us about your FITNESS Goals: What 1-3 specific fitness goals would you like to work towards during your training?

Example: Become more flexible + improve my posture, Compete in a bikini competition, Run a marathon in under (4) hours, etc.

Goal 1:

Do you have any pre-existing or current conditions, injuries, irritations or complications?

Neck/Back

Shoulder

Knee

Ankle/Foot

Hand/Wrist

No Current Injuries

Other

Summary and date of Injury

Please select all Practitioners you are currently working with.

Primary Care Physician

Physical Therapist

Chiropractor

Body Worker

Orthopedist

Other

Address

Street Address

City

State

Country

Country

Postal code

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