Full Name
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First Name
Last Name
Date of Birth
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MM
DD
YYYY
Gender
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Height
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Weight
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Email
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Phone (WhatsApp/iMessage)
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Country
(###)
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####
Location
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Instagram
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Referral/Where did you hear about me:
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What is your goal?
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In as much detail as possible, please tell me about your goals.
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(short-term and long-term goals)
Are you currently doing anything to help you achieve these goals?
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If so, please explain. How successful have you found this?
Do you have any specific dates/events you would like to work towards?
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On a scale of 1-5, how important are these goals to you?
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What do you believe is a realistic timeframe for you to achieve your goals?
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0-3 months
4-6 months
7-12 months
Over a year
How many days a week are you willing to commit to the training program?
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3 times/week or less
4 times/week
5 times/week
6 times/week
I will go on your recommendation
Do you ever meditate/journal/reflect?
What are your strengths? What do you love about yourself?
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What are your perceived weaknesses? Do you ever have negative thoughts towards yourself? If so, what are they?
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What external factors could prevent you from achieving your goals?
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What internal factors could prevent you from achieving your goals?
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On a scale of 1 to 5, how would you describe your understanding of nutrition?
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How would you describe your relationship with food? Please include any struggles with underrating, binging, restrictive dieting, fussy eating or previous or potential disorders.
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Which answer best describes a full day of eating for you?
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I'm not sure
I am mostly on a liquid diet (alcohol/sodas/smoothies/juices)
My food choices are mostly "junk food"
My food choices are mostly "whole foods/healthy/balanced"
I have "good days" and "bad days
I'm a snacker/grazer
I do not think about the things I eat
Do you have any experience tracking your calories/macros?
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If so, what macros are you on and have previously been on?
Do you have any allergies or intolerances? Do you have any foods you like and dislike, or foods that affect you negatively?
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Please tell me about them.
How does your typical day look like?
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Please provide a 3 day food log of what you are currently eating
How would you describe your current lifestyle?
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Do you have any training/exercise experience?
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Do you do cardio?
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If you currently exercise, how long have you been doing this consistently for?
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0-3 months
4-6 months
7-12 months
Over a year
Which of the following do you have access to?
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How many days a week can you commit to training?
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1-2 days a week
3 days a week
4 days a week
5 days a week
6 days a week
Do you have favourite exercises/sports? What are they?
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What exercises or types of training are you apprehensive about?
On average, how much sleep do you get?
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Not really aware of it.
4 hours or less
5-6 hours
7-8 hours
9 hours or more
Do you have previous/current injuries?
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Anything not listed:
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Current Occupation
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Please list all medications, dosages, purposes and side effects. If you don't take any, just type none
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Are you pregnant?
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Yes
No
If pregnant, how far along are you?
Are you currently on any contraception? Do you experience any irregularities with your periods?
How much water do you drink daily?
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Have you undergone a complete medical exam in the past 3 years?
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Have you had a complete hormonal panel done in the past year?
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Any major surgeries or have you been hospitalised in the last 12 months?
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If yes, please explain. If none, just type none.
Have you experienced or are currently suffering from any of the following?
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Do you have a support system in place?
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Yes
No
Do you currently smoke?
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Yes
No
Do you currently drink?
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Yes
No
Are you responsible for looking after children?
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Yes
No
Do you track daily steps? If so, how many on an average day?
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Anything else you would like me to know about you?
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I would describe my coaching as intuitive and firm but fair - I will be your biggest cheerleader but not an enabler for excuses (excluding genuine reasons of course!!) 😚🫶🏻 do you have a preference with a 'coaching style'. Would you hypothetically prefer to take a 'tougher', efficient approach or a more relaxed, balanced approach?
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Desired start date
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MM
DD
YYYY
CLIENT WAIVER AND PHOTO/VIDEO CONSENT
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