Meal Plan/ Training Program Form

Full Name

First NameLast Name

Date of Birth

Date

Email Address

example@example.com

Phone Number

Height (cm)

Weight (kg)

Please list any current or previous relevant injuries (if any)

List any relevant current medical conditions (if any)

List any relevant medication you are currently taking and why

Please list any relevant allergies (if any)

Occupation

Activity Level

Other

If currently following training program, describe below

Sleep Quality

Stress Levels

How would you describe your current diet?

List any food allergies and preferences, likes and dislikes

**If you are getting any meal plan this will be very required

Alcohol Intake

Daily Water Intake (liters)

Dietary requirements (vegan, vegetarian, etc.)

What is your main health and fitness goal? Be as specific and as optimistic as you can be!

e.g. To lose 10kg and maintain the weight loss

Preferred Training Style

How many days per week do you currently train?

Equipment Access

What motivates you?

What are potential barriers to achieving your goals?

Any additional Information

I understand that participation in a coaching program involves certain risks. I hereby release the coach from any liability for injuries or damages that may occur during my participation. Medical Clearance: I confirm that I have consulted with a healthcare professional and have been cleared to participate in physical activity. Data Consent: I consent to the collection and use of my personal information for the purpose of providing coaching services. I agree that i have answered each question truthfully and to the best of my ability

Electronic Signature

How did you hear about me?

My Products

Custom Training program (single)

One-on-one coaching session (60 minutes)

$99.99 AUD

Custom Meal Plan (single)

A custom made meal plan tailored to your goals and requirements

$119.99 AUD

Training and meal plan combo

1 x Custom training program and 1 x custom meal plan to help you get kickstarted on your health and fitness goals!

$199.99 AUD

Enter coupon

Total

Please read and accept the following terms and conditions to proceed with your coaching program enrollment. By signing below, you acknowledge that you have read, understood, and agree to be bound by these terms. These terms govern your participation in the coaching program and outline the responsibilities of both you and the coach. If you have any questions or concerns, please address them with the coach before signing this agreement. Thank you for your cooperation and we look forward to working with you towards your goals.

Payment Methods

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Choose from one of the PayPal options to make your payment.

CLIENT INTAKE FORM

My Products

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