Name
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First Name
Last Name
Email
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Date of Birth
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MM
DD
YYYY
Address
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Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Please choose one of the below methods for me to calculate your body fat %:
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1. Skin fold method. I need 7 measurements in mm:
chest, abdominal, thigh, tricep, subscapular, suprailiac, midaxillary
2. Dexa / InBody / Evolt / Tanita scan
3. Tape measure method: I need 3 measurements in cms:
neck (widest point) waist (around belly button), hips (around bum)
Describe the goals you want to achieve, and why it is important to you
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In detail describe any of the following: your body composition goal; strength goals; lifestyle goals; habit goals (e.g. to look and feel fit and strong, be more consistent with drinking enough water each day, prioritising meal prep, and getting strong in the gym)
What has/has not worked for you in the past regarding diet and training?
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What is your main obstacle to achieving your goal?
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What do you think needs to be improved most with your current nutrition & Why?:
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Do you have any health/medical conditions? If yes please list them and detail how these may impact your training or goals
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Are you taking any medications? If yes please list them below
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Please list any special dietary requirements you have including any intolerances. or allergies
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Please list any foods you don’t want on your diet.
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Do you currently take protein powder? What is the brand and specific product? If you don't take anything, are you open to trying it?
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Please list any foods you DO want on your diet, and email me photos of nutrition panels or list exact brand and product names
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Please list the foods and drinks you would typically consume in one day, including supplements, and water intake
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If it varies, or you have good days and bad days, please give an example of a ‘bad day’. Please list as Meal 1, meal 2 meal 3… etc. Provide as much detail as possible
How much alcohol do you typically drink per week? (e.g. 4 standard drinks twice a week)
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Would you be willing to give up drinking alcohol, or cut back significantly, to achieve your goals?
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What is your job? Are you mostly sedentary, moderately active, or very active?
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Are you currently exercising? If yes, please outline a typical week of exercise.
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Do you have any weights training experience, in particular with deadlifts, squats, leg press, bench press, seated military press? Please elaborate.
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What muscle groups, or exercises do you want/need to focus on?
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What is your max (PB) barbbell bench press, barbell back squat and conventional/sumo deadlift? (1 to 10 rep maximum) or what is the most weight you have lifted recently (within the past 2-4 months)? If you are unable to do any of these exercises due to injury please provide similar best performances (e.g. best leg press weight & reps if unable to do barbell squats)
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Have you ever had a personal trainer?
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Please list all past and current injuries if any.
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Where will you be training? (i.e. gym or home gym)
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Basic requirements for a gym are: barbell, squat rack, plates, dumbbells, adjustable bench, leg press, leg curl, leg extension, cable row, lat pulldown.
Please list the equipment you have if training at home.
How many training sessions per week can you do? (workouts typically take 60mins)
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Do you have a preference for what days of the week you train on?
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How did you find out about me?
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Referral
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