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Fitness Coaching Questionnaire

Ready to start your fitness journey? Fill out this coaching questionnaire and pay the $40 Virtual Consultation deposit and we will hop on a zoom call, discuss your form and a strategy to get you to your goals.

SECTION 1: PERSONAL INFORMATION

2. Birthday
Month
Day
Year

Used to send motivational tools, printed materials and achievements as required.

5b. Preferred Method of Contact
Call
Text
Email
Best Time for Conferences
Morning
Mid-Day
Early Evening
Late Evening
Weekends

SECTION 2: FITNESS AND HEALTH ASSESSMENT

A. GENERAL HEALTH ASSESSMENT

(Failure to Answer all of the following questions will lead to us being unable to assess you completely and may delay your 1on1 call)

6. Have you ever been diagnosed with a medical condition that may affect your ability to participate in a fitness program?
Yes
No
If yes, please explain:
7. Are you currently under the care of a physician for any medical conditions?
Yes
No
If yes, please explain:
8. Have you had any surgeries, hospitalizations, or major injuries in the past 5 years?
Yes
No
If yes, please explain:
9a. Do you have any current injuries, joint. pain, or movement restrictions?
Yes
No
9b. If yes, which areas?:
Back
Knees
Shoulders
Hips
Other
10. Have you ever experienced dizziness, fainting, or shortness of breath during exercise?
Yes
No
11. Have you ever been advised by a healthcare professional to avoid exercise?
Yes
No
If yes, please provide details:
12. Do you have high blood pressure, heart disease, or a family history of heart related issues?
Yes
No
13. Do you have asthma, respiratory conditions, or difficulty breathing during exercise?
Yes
No
14. Do you have diabetes, thyroid conditions, or metabolic disorders?
Yes
No
15. Do you experience chronic pain or inflammation (arthritis, fibromyalgia, etc.) ?
Yes
No
16. Do you have digestive issues (IBS, acid reflux, etc.) that may impact nutrition or exercise?
Yes
No
17. Are you currently pregnant or postpartum (within the past 6 months)?
Yes
No

B. LIFESTYLE & FITNESS HABITS

18. How would you rate your current fitness level?
Beginner
Intermediate
Advanced
19a. Do you currently exercise regularly?
Yes
No
If yes, how many times a week?
19b. What type of exercise do you currently do? (Check all that apply)
20. What is your primary fitness goal? (check all that apply)
21. On a scale of 1-10, how committed are you to reaching your goal? (1+ Not Ready, 10= Fully Committed)
22. What is your biggest challenge when it comes to fitness and nutrition?
Time
Motivation
Knowledge
Injury
Consistency
Nutrition
Other
23. How many hours of sleep do you get per night?
Less than 5
5-6
7-8
9+
24. How would you describe your stress level?
Low
Moderate
High
Very High

C. NUTRITION & SUPPLIMENTATION

25. How would you describe your eating habits?
Balanced
Mostly Healthy
Inconsistent
Needs Improvement
26. Do you track your food intake?
Yes
No
27. Do you have any food allergies or dietary restrictions?
Yes
No
If yes, please specify:
28. Do you currently take any vitamins, supplements, or medications that could affect your fitness program?
Yes
No
If yes, please list them:
29. How much water do you drink daily?
Less than 4 cups
4-6 cups
7-9 cups
10+ cups
30. Do you consume caffeine or pre-workout supplements?
Yes
No

SECTION 3. PROGRAM PREFERENCES & EXPECTATIONS

31. How many days per week are you realistically able to commit to training?
1-2
3-4
5+
32. Do you prefer:
In-Person Training
Virtual Training
Hybrid
33. What type of workouts do you enjoy the most?
Strength Training
Cardio
HIIT
Yoga/Pilates
Other
34. What is your preferred training time?
Morning
Afternoon
Evening
Other
35. Do you have any prior experience with personal training or structures fitness programs?
Yes
No
If Yes, What worked well for you?
36. Is there anything else you'd like me to know before we start training?
Yes
No
If Yes, please share here:

SECTION 4: LIABILITY WAIVER & AGREEMENT

If you do not agree to the terms below you will not be cleared to start a fitness program here.

37. Do you understand that physical exercise carries inherent risks, and you accept full responsibility for your participation?
Yes
No
38. Do you acknowledge that I am not a medical professional and that this program is for general fitness purposes only?
Yes
No
39. Do you agree to follow safety guidelines, communicate any discomfort or injuries, and modify exercises as needed?
Yes
No
40. Do you agree to the program’s cancellation, rescheduling, and refund policies as outlined in our Terms & Conditions?
Yes
No
Fixed price
$40

NEXT STEPS:

✔️ You complete this form

✔️ I review your responses, we discuss your personalized training plan.

✔️ You sign up for a Coaching Plan and pay deposit

✔️ You will receive onboarding details, fitness and meal plan details, session scheduling, and next steps to kick off your fitness journey!

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