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Online Coaching Client Analysis
Please complete the form below with as much detail as possible
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Email
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Record my email address with my response
Name
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Your answer
Age
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Your answer
Height in CM
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Your answer
Current Weight in LBS
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Your answer
Injurys or Medical conditions/food intolerances or allergies
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Your answer
Specific Goals, eg. Weight loss, Muscle Gain, Athletic Performance
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Your answer
Current Training Regime
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Your answer
Activity Level
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Sedentary (little or no exercise)
Light (1-3 days exercise a week)
Moderate (3-5 days exercise)
Active (6 or more days a week)
Extreme (Very heavy exercise/physical job/training twice daily)
Are you pregnant, suffer from PMT, Perimenopausal or Menopausal ?
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Your answer
What are your energy levels like on a daily basis? High/Low. Please give a brief explanation of your answer
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Your answer
Are you currently taking any medication? Do you have any medical conditions, such as diabetes or hypothyroidism?
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Your answer
How many hours sleep do you average per night? Do you have trouble falling asleep or staying asleep? How do you feel upon waking? (refreshed/still tired)
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Your answer
Is there anything else pertaining your health and dietary lifestyle that you feel is important or that we should be aware of?
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Your answer
CLIENT DECLARATION
I understand and acknowledge that the services provided are at all times restricted to consultation on the subject of health matters intended for general well-being and are not meant for the purposes of medical diagnosis, treatment or prescribing of medicine for any disease, or any licensed or controlled act which may constitute the practice of medicine. If you're unsure about your current health and/or well-being, please consult your GP before filling out this form. This statement is being signed voluntarily.
Forged In Fitness does not accept responsibility for any illnesses or injurys that occur during your programme or thereafter.
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