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1-on-1 Coaching Initial Assessment

Please fill out this assessment in as much detail as possible. Please note that the answers will not save if you exit out of the page without submitting it at the end. I'd recommend blocking off at least 20-minutes to complete this! The more detailed you are, the better! :)

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Question 1 of 33

First and Last Name

Question 2 of 33

Email

Question 3 of 33

Phone Number

Question 4 of 33

Shipping Address

Question 5 of 33

Age

Question 6 of 33

Birthday (Month/Day/Year)

Question 7 of 33

Height & Weight

Question 8 of 33

What is your current job/occupation?

Question 9 of 33

Do you have a partner? Kids? Grandkids?

 

If so, do you live with them? How old? 

Question 10 of 33

How did you hear about me?

Question 11 of 33

Do you have any medical conditions (i.e. Heart problems, respiratory problems, chronic illness, etc.)

Question 12 of 33

Are you currently taking any medications? (If so, please list).

Question 13 of 33

Are you currently consuming any supplements? (If so, please list).

Question 14 of 33

Are you suffering from any injuries that impact your daily life or workout abilities?

Question 15 of 33

Do you have any dietary restrictions?

Question 16 of 33

What is your work schedule? And does it interfere with your nutrition, training, or sleep schedule?

Question 17 of 33

Daily activity level? (If you track your steps, please provide this. How often are you on your feet compared to sitting down, day to day?)

Question 18 of 33

Do you currently track calories and macros (carbs, fat, protein) using a tracking app? If yes, what app do you use and what are your current macros. If no, have you tracked macros in the past?

Question 19 of 33

How many calories would you estimate you are currently consuming on a daily basis?

Question 20 of 33

On average, how many alcoholic beverages do you consume WEEKLY?

A

None

B

1-3

C

4-6

D

Too many to count

Question 21 of 33

What past diets/eating plans have you tried? What has and what has not been successful (and why)?

Question 22 of 33

How's your relationship with the scale? Do you ever weigh yourself?

Question 23 of 33

What is your current nutrition and eating plan like? (Foods, times, frequency, etc.) 

Question 24 of 33

What is your current training/exercise program like? (Days per week, duration per session, upper/lower split, full body, CrossFit, Orange Theory, running, etc. - the more detail the better)

Question 25 of 33

Are you currently doing any cardio/conditioning? If so, how much and what type?

Question 26 of 33

What are the struggles, deviations, or stressors you currently face with nutrition and training?

Question 27 of 33

What type of exercise/training do you enjoy most?

Question 28 of 33

What are your goals and desired outcomes from this coaching program? (Be specific!)

Question 29 of 33

How can I be the most helpful coach during our time together?

Question 30 of 33

Any expected travel or major social events coming up in the near future (within 3-6 months)?

Question 31 of 33

Describe your personality type as best you can. (Are you a planner? Prefer to go with the flow? Need lots of change/variation? Prefer sticking to the same routine daily? Motivated by fast progress? Better with slow and steady progress?)

Question 32 of 33

If applicable - what gym and/or equipment do you have available? (Please list everything...kettlebells, sleds, rower, stationary or airdyne bike, barbells, ropes, etc.)

Question 33 of 33

Please list any other info/questions you think would help me.

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