Coaching - House of Transformation

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Personal information

First name*

Last name*

Email*

Age

Gender

Male

Female

Physical information

Current weight

Height

Goal weight

Current body fat % (estimate)

Known medical conditions

Current medication

Fitness History

Current level of fitness

Beginner

Intermediate

Advanced

I work out at...

The gym

Home

Fitness classes

Weightlifting (strength training only)

Weight lifting frequency

None

1-2 days per week

3-4 days per week

5 or more days per week

Minutes per day

None

0-30 min

30-60 min

60+ min

Weight lifting intensity

Light – I can hold a conversation

Moderate – I am breathing hard

Difficult – Can't talk, busy sweating

Intense – I seriously might die

Cardio & Group Fitness (combine them if you do both)

Cardio & group fitness frequency

None

1-2 days per week

3-4 days per week

5 or more days per week

Minutes per day

None

0-30 min

30-60 min

60+ min

Cardio & group fitness intensity

Light – I can hold a conversation

Moderate – I am breathing hard

Difficult – Can't talk, busy sweating

Intense – I seriously might die

Any previous or current injuries or surgeries

Fitness Goals

Specific Fitness goals for next 30 days

Fitness objectives (Lose weight/Gain Muscle/Increase Stamina etc.)

Ultimate Fitness goal

Lifestyle information

How active is your job and daily routine?

Sedentary – Desk job / work from home / very little activity

Lightly active – Teacher / usher / some standing & moving

Moderately active – Server / trainer / nurse / mostly standing & moving

Very active – Construction worker / farmer / mostly moving & lifting

What time do you typically go to sleep?

How many hours on average do you sleep?

How would you rate your sleep quality overall 1-10 (1 awful - 10 excellent)

Dietary information

Current eating habits

Nutritional preferences

Standard western

Vegan

Vegetarian

Pescatarian

Polloterian

Pesce-pollotarian

Low carb

Dietary restrictions

Current supplements usage

Availability

Days per week available for training

Preferred times for exercise

I'm most interested in

One on One Personal Training

Small Group Training

Online Training

Doing it alone

If you were to work with a trainer one on one would you prefer

Male

Female

No preference

Free Coaching Consultation

Personal information

Physical information

Fitness History

Weightlifting (strength training only)

Cardio & Group Fitness (combine them if you do both)

Fitness Goals

Lifestyle information

Dietary information

Availability

Location

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