First name
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Last name
*
Email
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Confirm email
*
Occupation
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What do you do for a living?
Were you referred by a current client? If so, who?
*
Gender
*
Male
Female
Transgender
Prefer Not To Say
Date Of Birth
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MM/DD/YYYY
Age
*
Not Shown
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
Height
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In ft. & in.
Current Weight
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In pounds (lbs)
How many years of structured weightlifting experience do you have?
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Less than 1 year
1-4 years
5+ years
This does not include at-home dvd workouts and classes
What is your primary body composition goal?
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Fat Loss
Muscle Gain
Fat Loss = Calorie Deficit/Losing Weight (Body Fat); Muscle Gain = Caloric Surplus/Gaining Weight (Muscle + Minimal Fat)
How active are you outside the gym?
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1
2
3
4
5
6
7
8
9
10
1 - Sedentary -> 10 - Super Active
Have you ever worked with a personal trainer/coach (either in person or online)? If yes, what was your experience?
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Are you following any exercise/training routine, currently?
If 'yes', please tell me about it below
Please list any medications and/or supplements you are currently taking.
*
Are you pregnant or might be pregnant?
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Are there any obstacles that usually prevent you from working out?
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If yes, explain.
Are you already experienced with flexible dieting (IIFYM/tracking macros/calories)?
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Yes
No
Somewhat
This means using apps like MyFitnessPal, MyMacros+, or similar
Do you ever binge-eat?
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If yes, what triggers it? Please explain below
How often do you drink alcohol?
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0-3 drinks
4-8 drinks
8+ drinks
Honest estimate
Do you smoke?
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Yes
No
Sometimes
Do you have any health issues or past injuries we should know about, such as asthma, diabetes, back pain, etc, I should know about?
*
If 'yes', please explain here.
Tell me a bit about you, your experience with training and nutrition and how it's impacted your life whether negatively and/or positively
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What would make this experience the best you ever had?
*
Apply