Online Personal Coaching - Consultation Form
Full Name : *
Gender : *
Email : *
Country : *
Which country do you currently reside in?
Which service are you most interested in? *
What are your current goals and expectations from this service? *
What have been some of the struggles you've faced with achieving this goal? *
How long have you been training in total? *
(minus any extended periods of time off)
Please describe your current activity level and type *
(i.e. weights 3x week Push/Pull/Legs. Cardio - 3x week jogging HIIT etc)
On a scale of 1-10 how happy are you with your current training and nutrition protocol? *
Hate it
Love it
On a scale of 1-10 how far along are you towards your goal? *
Not even close
Totally Satisfied
Is there anything at all you'd like to add which may help with your consultation/coaching?
Would You Like a Skype or Phone Consultation to Discuss Your Custom Plan/Coaching?
Skype ID or Contact Number (if you answered "Yes" to the last question)
Physical Activity Readiness Questionnaire (PAR-Q)
(Please answer the below questions as honestly as possible)
Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by your doctor? *
Do you ever feel pain in your chest when exercising? *
In the past month, have you ever felt pain in your chest when NOT exercising? *
Do you lose your balance due to dizziness, or do you ever lose consciousness? *
Do you have a bone or joint problem that could be made worse by physical activity? (i.e. back, knee, shoulder) *
Is your doctor currently prescribing you drugs for a heart condition or blood pressure? *
Do you have any other known injuries/allergies/illnesses that would affect your training/coaching?
Please be as detailed and as honest as possible
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