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Fitness Coaching Application
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Name
Your answer
Phone Number
Your answer
E-mail
Your answer
Your Preferred Communication Method
Email
Phone
Text Message
Skype
Other:
Gender
Male
Female
Other:
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Age
Your answer
Height
Your answer
Weight
Your answer
Resting Heart Rate
Your answer
Blood Pressure
Your answer
Approximate Body Fat Percentage
Your answer
How did you hear about my coaching program?
Your answer
Can you briefly describe your specific, short-terms goals (with the next 12 weeks)?
Your answer
Can you briefly describe your long-term goals (over the next year)?
Your answer
Do you have any specific injuries or medical conditions that you’re dealing with? If so please detail below:
Your answer
Are you training consistently?
Yes
No
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How would you rate your current level of fitness?
Sedentary
1
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5
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8
9
10
Superhuman
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Briefly describe your current strength training routine.
Your answer
Briefly describe your current cardio routine.
Your answer
Do you have any Martial Arts, Boxing, or Kickboxing experience? Would you be interested in making it a part of your fitness program?
Your answer
What type of fitness equipment do you have access to? Please list below:
Your answer
Any Favorite Exercises?
Your answer
Any Exercises You Want to Avoid?
Your answer
Are you willing to invest $200 to $600 per month into improving your health and fitness?
Yes
No
Maybe
Clear selection
On a scale of 1 to 10, how committed are you to following through on your fitness program?
Commitment issues
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2
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4
5
6
7
8
9
10
Maximum Effort
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