New Client Questionnaire

Boxes with (*) are required.


Name (*):



Phone (*):



Email (*):



Skype (if you have one)



WhatsApp (if you have one)



Address:



Suite/Apt:



City (*):



State (*)



Zip Code (*)



Referral(s):
FacebookInstagramSearch Engine(s)Other * (Friend or Client)


Friend or our client Name*:



Your Information
Gender(*)
MaleFemale


Age



Height



Current Weight



Current Body Fat (Optional)



What's Your Fitness Goal? (Please specify to the best of your ability)





What Are Your Current Eating Habits?





List top 5 foods you enjoy eating. (based on your goal and foods nutritional value, some might be used on your meal plan)





What food(s) do you dislike? (without being took picky)





Amount of days you want to workout per week?




Pick Days (optional)
SundayMondayTuesdayWednesdayThursdayFridaySatuyrday
What Time of Day do you want to work out?



Areas you want to focus on?
LegsGlutesChestBackShouldersAb/Rid Stomach FatArmsOther (descibe below)





What type of gym will you be working out of?
Full size gymFitness CenterHome Gym w/EquipmentYour Home no EquipmentOther
Other Gym





If you're working out from your home or home gym, please give me a list of all the equipment you have access to?





Fitness Level?(*)
BeginningIntermediateAdvancedBeast
Describe your Daily Activity Level?





Do you have any Allergies?(*)
YesNo
If Yes, please explain



Any injuries/limited range of motion/discomfort while exercising? (*)
YesNo
If Yes, please explain





Name of former online coach (if any) Tell me about your experience