COACHING INTAKE FORM
This form helps me understand your goals, training experience, schedule, and any limitations you may have. Please answer everything honestly - your program will be fully customized based on your responses. This is the first step towards becoming your strongest and most disciplined version of yourself. Lock in.
Full Name
*
First Name
Last Name
What is your age?
What is your height?
What is your weight?
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
What is your primary fitness goal?
*
Lose weight
Build muscle
Recomp (build muscle + lose body fat)
Build Strength
Other
How would you describe your current physical activity level?
*
Sedentary (little or no exercise)
Lightly active (light exercise 1-3 days/week)
Moderately active (moderate exercise 3-5 days/week)
Very active (hard exercise 6-7 days/week)
Other
Where will you be training?
*
Home
Gym
Other
How many days a week can you realistically train?
*
3
4
5
6
7
How long do you want your workouts to be?
*
30-45 minutes
45-60 minutes
60-75 minutes
75+
What type of workout split do you prefer?
*
Full Body
Upper/Lower
PPL (push, pull, legs)
Bro Split (1 muscle group per day)
No Preference
Other
Are you currently following a nutrition plan?
*
Yes
No
Other
Do you have any current or past injuries, medical conditions, or other health concerns we should be aware of?
How would you prefer to be contacted?
Email
Text message
Submit
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