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Coaching Application Form
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* Indicates required question
Email
*
Your email
Name
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Your answer
Age
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Your answer
Height (ft)
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Your answer
Current Weight (KG)
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Your answer
Lowest bodyweight in the last 12 Months
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Your answer
Date of birth
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MM
/
DD
/
YYYY
Male
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Male
Female
Other:
What is your occupation?
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Your answer
How did you find out about me/my service?
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Your answer
Where are you from/where do you live?
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Your answer
How many times a week can you train?
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Your answer
Do you have a gym membership
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Yes
No
No, but can get one.
Do you (or have you in the past) lift weights/resistance trained
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Your answer
What are your work hours and what time of day do you prefer to train?
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Your answer
Daily Activity (Steps/manual labour etc)
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Your answer
What's your current training regime?
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Your answer
Do you currently do any cardio? (How much and how long)
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Your answer
Do you have any injuries at this moment in time? If yes, please explain in detail.
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Your answer
Do you have any past injuries that I should consider? If yes, please explain in detail.
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Your answer
Tick the box that best represents your fitness journey in the last 6 months
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Consistent with set goals
Lack of direction/going through the motions
Ive been inactive
Required
Have you ever used a coach before?
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Yes
No
Explain with as much detail as possible your current fitness goals.
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Your answer
Whats your desired end goal from this process?
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Your answer
Do you have any lifestyle limitations that may prevent you from achieving your goals?
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Your answer
Do you have low blood pressure?
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Yes
No
Do you have high blood pressure?
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Yes
No
Do you have a metabolic disease (Including Diabetes)
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Yes
No
Do you have any underlying health conditions I should know about? If yes, please explain in as much detail as you feel comfortable with.
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Your answer
Is your doctor currently prescribing you any medication?
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Your answer
Do you have trouble falling asleep?
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Your answer
Do you suffer from bloating and/or indigestion?
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Your answer
Are you stressed/what is your main cause of stress?
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Your answer
Training experience
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Beginner
Intermediate
Advanced
Other:
Do you/have you used MyFitnessPal or Nutracheck?
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Yes
No
If tracked, what is your current daily macros/calories intake?
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Your answer
Describe your diet/daily food intake in as much detail as possible.
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Your answer
Do you have any allergies/intolerances?
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Your answer
What are your perceived weaknesses in your physique?
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Your answer
Mobile Number
*
Your answer
Finally, what's your dream outcome from working with me?
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Your answer
Click 'Submit' and book your free consultation.
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