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Questionnaire / Consult Form
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How did you hear about my Online Coaching?
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Instagram
Facebook
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Referral / Word of Mouth
Other:
About You
Some basic information required for me to get to know you a little better.
Full Name
Your answer
Date of Birth
MM
/
DD
/
YYYY
Age
Your answer
Weight
Your answer
Height
Your answer
Location
Your answer
What is your occupation?
Your answer
Tell me a little about you
Your answer
Training / Exercise
These questions give me an insight into your current training, your interests, likes, dislikes and training experience.
Tell me a little about your exercise / training history - what you enjoy / don't enjoy, how long you have been training, what sort of training you have been doing.
Your answer
How many times per week do you currently training?
Your answer
How many times per week can you train? Time and days? (i.e.. 4 times a week for 1 hour). Please be realistic.
Your answer
Rate your overall daily activity levels.
Sedentary (eg. you sit at a desk all day)
Moderately Active
Active
Very active
Clear selection
What training equipment do you have available to you? Do you have access to a fully equipped gym?
Your answer
Do you have experience with weight machines, free weights, barbells etc?
Your answer
Do you enjoy weight training? If yes, please specify why. If no, please specify why.
Your answer
Do you have any injuries, health concerns or illnesses that I need to be aware of? If yes, please specify.
Your answer
Your Goals.
Please provide as much detail as possible. I want to see you succeed and you providing me with as much information as possible allows us to work together well.
What goals would you like to achieve in the next 8 weeks?
Your answer
Why are these goals important to you?
Your answer
Is there anything stopping you from achieving these goals?
Your answer
What have been some of your greatest accomplishments in life?
Your answer
What type of approaches discourage or take away your motivation?
Your answer
Nutrition
Have you counted macros or calories before?
YES
NO
Clear selection
Do you know how to use My Fitness Pal?
YES
NO
Clear selection
Do you know your current calorie intake? If yes, please note.
Your answer
How many times a day can you eat? (e.g.. Break, Snack, Lunch, Dinner or Breakfast, Lunch, Dinner). Please specify.
Your answer
Please list your favourite foods.
Your answer
Please list your least favourite foods.
Your answer
Do you have any allergies / intolerances?
Your answer
Do you drink more than 10 standard drinks per week?
YES
NO
Clear selection
Do you smoke?
YES
NO
Clear selection
Do you have any struggles with nutrition? If so, please specify.
Your answer
Your Coaching Experience
What do you want from your coaching experience with me as your coach?
Your answer
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