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1:1 Coaching
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Home
About
1:1 Coaching
Testimonials
Training App
Contact
Guides & Challenges
Cart
Intake Form
Name
*
First Name
Last Name
Email Address
*
Message
*
Choose which plan you have more intrest in
Macro Plan
Meal Plan
Do you currently have a gym memebership? If no, describe what equipment you do have.
Date of birth
*
Year
1960
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Month
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Day
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Height in inch
What is your current weight? Ideally what weight do you think you would be your healthiest and strongest.
Phone number
Occupation/ Daily activity summary
Are you currently pregnant?
Yes
No
Health Questionnaire
The following information is not required to be filled out. However, I do recommend you filling out the following information and accuratly as possible. That will allow for me as a coach to provide you with the most customized expirence as possible. Please note that any false
Do you have any pre existing health conditions that would impare your ability to perform vigrous acitivty
Yes
No
Are you currently on an perscriptions that may alter the way your body responds to exercise and or diet
Birth Control
Hypertension
Cancer
Depression/ Anxiety Medications
If yes to any of the previous above, please describe how long you have been using said medications or if you are on multiple.
Describe your current diet. If you track macros please include your current numbers.
How Many Days a Week Can You Workout
1-3
3-4
4-5
6-7
Do you have a gym membership? If no describe what fitness tools you have at your access
Are you currently active? "Working out at least 3x a week" If yes, please describe what you have been doing.
Do you currently have any eating disorders or mental health conditions? If yes, please describe.
I agree that the information above is filled out as accuratly as possible
*
yes
no
Electronic Signature
Thank you!
