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Online Coaching Questionnaire
I am extremely excited to work with you! Once you have submitted the form, I will send you a WhatsApp message to get you started. If you have any other questions, don't hesitate to contact me!
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* Indicates required question
Email
*
Your email
Name
*
Your answer
Surname
*
Your answer
What is you cellphone number?
*
Your answer
What’s your gender?
*
Female
Male
What is your goal?
*
Lose fat
Maintain
Build Muscle
Health
Other:
Required
Please explain why you chose this goal and why it is important for you to achieve it.
Your answer
What is your age?
*
Your answer
Height (cm)
*
Your answer
Weight (kg)
*
Your answer
What is your daily activity level?
This does not include any exercise you might do.
*
Sedentary (desk job / less than 3000 steps per day)
Lightly Active (desk job / 3000-8000 steps per day)
Moderate Daily Activity (desk+ standing job / 8000-12000 steps per day)
High Daily Activity (physical job or hard labor / 12000-15000 steps per day)
Do you exercise regularly?
Please explain (resistance training/ cardio/ walking/ how many times per week for how long etc)
*
Your answer
What is your average steps per day?
(You can check the step tracker on your phone)
*
Your answer
Have you ever counted calories or macros?
*
Yes
No
If yes, do you know what your estimated maintenance calories are?
Your answer
Has a medical doctor ever diagnosed you with a chronic disease, such as heart disease, hypertension, high cholesterol, or diabetes?
(If YES, please explain.)
Your answer
Are you currently taking any chronic medication?
(If YES, please explain.)
Your answer
Are you interested in any of the
Coaching Options?
(Full App Access)
*
1:1 Online Coaching (training and nutrition)
Online Training (including app access)
Online Nutrition Coaching
Other:
Required
Would you like a home or gym-based program?
Home
Gym
Other:
Clear selection
If you chose home-base, what equipment do you have available to you?
Your answer
If you train in the gym, are you comfortable in all areas of the gym? (for example the weight section)
Your answer
Do you have experience in training?
Beginner
1
2
3
4
5
Very advanced (5+ years of structured training)
Clear selection
How many days do you like to train?
Your answer
What is your preferred training duration? (i.e. 1 hour)
Your answer
Any injuries that I should be aware of?
Your answer
Do you understand that this program does not constitute medical advice in any way and that the author will not be held liable for any injuries, loss, or damage that may arise out of improper use or reliance on this program?
*
Yes, I understand
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