Ongoing Coaching Form

CLIENT INTAKE FORM

Lets get started!
Full Name

First NameLast Name
Email Address
example@example.com
Phone Number
Date of Birth

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Weight (kg)
Height (cm)
Please list any relevant current or previous 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
Progress Pic (FRONT)

NOT REQUIRED IF UNCOMFORTABLE**
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Progress Pic (REAR)

NOT REQUIRED IF UNCOMFORTABLE**
Cancelof
Progress Pic (SIDE)

NOT REQUIRED IF UNCOMFORTABLE**
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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?

Other

CHECKOUT:

ONGOING COACHING (WEEKLY CHECK IN)

This is the best option for anyone serious about working together with ONYX to pursue your health and fitness goals. We will do weekly check ins and make any changes required. You will be kept accountable and on the right track! Price is $300AUD paid monthly

$300.00 AUD for each month

ONGOING COACHING (FORTNIGHTLY CHECK IN)

This is a good option for anyone serious about working together with ONYX to pursue your health and fitness goals. We will do fortnightly check ins and make any changes required. You will be kept accountable and on the right track! Price is $200AUD paid monthly

$200.00 AUD for each month

Payment Methods
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year

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CLIENT INTAKE FORM

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