Barbell Medicine New Client Intake
Email address *
I am interested in the following *
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Name *
Your answer
Age *
Your answer
Gender *
Height *
Your answer
Height Units *
Body Weight *
Your answer
Body Weight Units *
Waist Circumference
Your answer
Waist Circumference Units
What are your goals? Please be as specific as possible. *
Your answer
If you are currently training, please provide your current squat, bench press, and deadlift numbers. Please include weights, units, and repetitions.
Your answer
How many days per week do you train, if you are currently doing so? What does your week look like from an exercise perspective?
Your answer
Are you currently or previously injured? Are there any movements you cannot perform?
Your answer
What type of training facility do you use now or have access to? What equipment do you have?
Your answer
If you are interested in nutrition coaching, what has your body weight trend been recently?
Your answer
Have you used any diet interventions in the last six to twelve months? If so, what intervention and how did that go?
Your answer
Please describe any allergies, diseases, or disorders you have.
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Please include any other pertinent info that you think our coaches should know.
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A copy of your responses will be emailed to the address you provided.
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