Online Coaching Program
The following is a detailed information sheet that we ask all of our online coaching members to fill out.

It provides us with an appropriate fitness background, nutritional background, contact information, personal information, etc., that will help us coach you better throughout the program.

It also lets us give you any appropriate upfront information regarding any potential medical concerns and other coaching tools we may want to use with you.

All information is required, unless otherwise noted, but none of this information will be shared with anyone except your coach.
Sign in to Google to save your progress. Learn more
Part 1 - Basic Information
First Name: *
Last Name: *
Date of Birth: *
Street Address: *
Suite #  |  Street #  |  Street Name
City: *
Country: *
Main Email Address: *
Secondary Email Address:
Primary Phone # *
*The Main Phone You Use
Alternative Phone #
Skype #
Google I.D. (Gmail Address)
Optional but we tend to use Google Hangouts in on Online Coaching Programs
More Specific Personal Information
Height *
Ideally in centimeters (inches x 2.54) but please list the units of measure if you opt for a different measurement system. We can convert it for you.
Current Weight *
Most recent time you've measured or best guess. Ideally in Kilograms (Pounds x 2.2) but please list the units of measure if you opt for a different measurement system. We can convert it for you.
I presently own a measuring tape: *
I presently own a scale: *
What Is your primary goal? *
How important is this goal to you? *
On a Scale of 1 to 10 ...
Not Very
Do you have a secondary goal?
Optional ...
If yes, what is your secondary goal?
Optional ...
Clear selection
How important is this secondary goal to you?
(Optional ...) On a Scale of 1 to 10...
Not Very
Clear selection
Please write as clearly as you can what you hope to get out of coaching. *
Please write at least one clear sentence.
Are there any specific details you would like to tell us about your objectives or goals? *
Please put N/A if not applicable to you...
Exercise Questions
Have you ever participated in an sport, athletic or physical exercise program before? *
In the past or currently...
If yes, please list some of the things you've done in the past.
In the past or currently...
How many times per week are you currently exercising? *
Choose 'Zero' if you are currently not exercising regularly...
Up until recently, how often did you exercise regularly? *
Choose 'Zero' if you have not exercised regularly in the last 6 months...
If you are currently exercising 3x per week or more, how long have you been exercising without a long break and what kind of exercise are you presently doing? *
Please put N/A if not applicable to you...
Have you ever been on a consistent exercise program in the past? *
At least 3x per week?
If you have exercised consistently, how long ago was that and how long did you do it for? *
Please put N/A if not applicable to you...
Medical and Health Information
If you have ever been clinically diagnosed with health problems, please list and describe those conditions here: *
Please put N/A if not applicable to you...
If you are presently (or have been within the previous 3 months) on any medications, please list and describe those conditions here: *
Please put N/A if not applicable to you...
If any, what additional therapies or interventions are being utilized for the listed health problem(s) or medication use above? *
Please put N/A if not applicable to you...
If any, please list any injuries you currently have or have dealt with in the past. *
Please put N/A if not applicable to you...
If any, what additional therapies or interventions are presently being undertaken for the listed injuries? *
Please put N/A if not applicable to you...
If you have any known food allergies, please list them below. *
Please put N/A if not applicable to you...
Lifestyle and Nutrition Information
What is your profession? *
i.e. What do you do for a living?
What is your work schedule like? *
*Check all that apply...
Do you travel for work? How Often? *
What is the activity level required of your job? *
*Choose the most applicable...
Are you the primary caregiver for children, individuals with any disability or an elderly relative? *
What hobbies, activities, committees or volunteer organizations are you involved with, outside of physical exercise and work? *
i.e. anything not related to your job or fitness, like the parent counsel, big brothers, model building, etc...
Do you have any physical, health, nutrition, or physique complaints and/or dissatisfaction? *
Please list, and briefly describe each one...
How many times per week do you shop for groceries? *
How many times per week do you eat out at fast food places on average each week? *
i.e. Mexican, Sandwiches, Italian, Burgers, Shawarma, or anything that offers takeout.
How many times per week do you eat out at more refined restaurants? *
i.e. Not fast food, no take out options (pre-pandemic), somewhere you can get a complete meal.
On average, how many hours of sleep do you get per night? *
Hours spent actually sleeping, do not include when you go to bed to read or watch TV.
On average, how would you rate the quality of your sleep? *
i.e. On a scale of 1-10 how refreshed, energized and ready to tackle the day do you feel on average?
Have trouble falling asleep, wake often during the night, and start the day feeling tired or wanting to sleep.
Wake up feeling refreshed, energized and ready to tackle the day.
Please list any foods you feel sensitive to, and what the sensitivity might be: *
i.e. excessive gas, bloating, stuffiness, congestion, or possibly diarrhea...
If you are currently using any nutritional supplements, please list them and the dosage you are taking: *
i.e. vitamins, minerals, oils, powders, etc...
Is there any other information your coach should know about your lifestyle or current nutritional intake? *
i.e. something you feel is important but no question was listed above...
Commitment and Coachability
Have you ever participated in any form of one-on-one, or group styled coaching program before? *
*This can be exercise, business, athletics, or nutrition related...
Are you willing to dedicate at least 2-3 hours of your time towards exercise and/or nutrition each week? *
Do you have, or are you willing to get access to a gym, home gym, or health club? *
(Typical memberships cost $30-80 / month depending on amenities...)
If we determine that you need additional help learning certain exercises, are you willing to hire a local fitness coach, physical therapist or personal trainer to teach them to you in person? *
(Typically a good fitness coach can make a significant impact in your movement within 5 sessions, costing roughly $50-80 per session, depending on the area)
If required for your goal; Are you ready and willing to spend 30 minutes each day, and at least 60 minutes one day a week (typically Sunday) to prepare and/or plan your own meals? *
You won't have to eat at home all the time, but cooking more of your own food will make things easier on you over the long-term.
Digital Photos and Video
Over the course of your program you may be asked to take digital photos and/or videos of yourself in small amounts of clothing. This typically means shorts or underwear for men and one or two piece bathing suits for women. Although sport bras and short shorts may be viable substitutes. This is optional but strongly recommended and encouraged.

We want you to be comfortable, but realize that some discomfort is needed for progress.

These images and video reveal a lot to your coach in terms of postural balance, movement quality and may influence your programming significantly. They are also a major metric of measurement in terms of reaching your objectives.

Don't worry, we will provide examples and detailed instructions on how to take, save and send them to us when we feel they are warranted. Usually at the very beginning of your programming at a minimum.

In this section, we politely ask all clients for permission to use these "before" and "after" photos for future case studies and promotional materials of future programs. Essentially if you get great results we want to share that experience and image for the future benefit of others, so that others may be inspired towards achieving physical transformation too.

If you choose to say no for now, you can change your mind later. You will still be able to participate in the coaching program if you don't want to provide consent to these photos and/or videos but we still strongly recommend you keep a qualitative record of change for your own records.

Of course, even if you consent to the release: we want you to know how much we respect your privacy and we will ALWAYS contact you directly before we use any of your photos and/or videos; You always have the option of having your face obscured, and your name altered to conceal your identity.

It's important to note that we wouldn't use your photos and/or videos, if they weren't a great example of physical change, so hopefully that is something to be proud of!

Please keep in mind that if you choose not to submit any photos/videos we request that that you limit our ability to coach you from a distance so please do the best you can. We feel that photos and videos are essential to success in this program for two reasons:

A) They tap into the visual cortex, which is more than 50% of our sensory input (no numbers can do this), which give us an instance picture of progress. If you want to change your body, you NEED to see whether the changes we're making are working (not just read the numbers...) and be able to compare those images to other images. The only way to do that is with photo and video, with photos obviously being the easier of the two to submit.

B) Numbers can be jaded and difficult for people to believe, even by you. Images and video provide the visual documentation of results that you (and others) will believe when they see. Your photos and video will probably be the single biggest contributing factor in convincing yourself that change is possible, occurred, and therefore will encourage you to continue along a great path of physical change or maintenance. Video and Photos are great motivational tools.

We highly recommend that you click yes to the photo and video consent below and provide any photos and/or videos when requested.
I Understand *
"I have read the above statements and understand them to be true in this section of the form. I know that failing to provide photos and/or videos at the regular intervals may hinder my results and lower the effectiveness of this coaching program."
Photo and Video Consent *
"I give Fettle Inc. the permission to use the photos and video I provide in case studies and promotional materials for future programs. I understand that I will be notified in advance of use, and that I will be given the choice to have my face obscured in the photos to conceal my true identity if desired."
Unaltered Photo/Video Consent *
"I know that it is my right to conceal my face but also that if I achieve incredible results, it would be really great to reveal my photos and videos unaltered to inspire others in their body transformations."
Medical Release
Although every client we've ever worked with has gotten healthier, more fit and has felt better with our help; we still require that you take full responsibility for your own health and the monitoring of it.

We need to be crystal clear in this.

Our advice cannot - especially online, in this distance-based capacity - replace the advice of a trained medical doctor.

If you have any doubts about your ability to physically participate in this program, it is your responsibility to check with your doctor prior to your participation in this program, and provide us with any notes, suggestions, or medical sign-off required PRIOR to your participation.

Furthermore, it your responsibility to work with your physician in these matters, before, during and after the coaching you will receive in this program with Fettle Inc. or any interaction with our employees or agents.

As such, any information shared with you by Fettle Inc., it's agents, officers, employers, employees or affiliated companies is NOT to be followed without the prior approval from your physician.

If you choose to use any of this shared information without the prior consent of your physician, you are agreeing to accept full responsibility for your decisions and agree to hold harmless Fettle Inc., it's agents, officers, employers, employees or affiliated companies from any liability with respect to injury to you, or your property arising out of or in connection with your use of the information shared or discussed.

Please use your common sense here.
I consent to this medical release *
"I have read the above medical release in it's entirety, and understand that it is my responsibility to address any medical concerns before participating in any programs Fettle Inc. offers. I know that Fettle Inc. and any related individuals or organizations will not be held responsible for any injury that may result in my decisions to ignore this medical release."
Clear form
Never submit passwords through Google Forms.
This form was created inside of Fettle. Report Abuse