MYOFIBER - Online Personal Coaching Program
Online training to achieve your goals.
Please answer the questions as best as you can.
Thanks!
Looking forward to working with you!
(By completing the form below, you consent to your information being used for the sole purpose of Online Coaching with Myofiber Canada and you agree that you are starting this coaching program on your own accord through the guidance and suggestions of Myofiber Canada. If anything unpleasant were to happen during the time you are working with Myofiber Canada, you also agree that you will not hold them responsible.)
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Email *
Name: *
Telephone#: *
Have you used Zoom before? *
Address: *
Date of Birth: *
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Weight (specify lb or kg) *
Height in inches or cm: *
Body fat %?
Did anyone refer you to this application form? If yes, who? *
Occupation and indicate # of hours sitting and/or standing: *
Do you have a favourite TV show/ book/ movie? Please mention it here! *
Medical conditions including previous injuries or surgeries (appendectomy, asthma, high cholesterol, knee injury etc). Please be specific: *
Are you on any medication and/or supplements? If so, please elaborate: *
Have you ever had a personal coach before? If yes, what was the experience like?
On a scale of 1-10, what would you rate your fitness level? *
Never exercise and am out of breath easily. Can barely walk up a flight of stairs.
Can do 100+ push-ups, run 10km easily and lift twice my bodyweight.
What are you hoping to achieve? Try to be as detailed as possible *
At the moment, what activities are you involved in and do you currently exercise? Please indicate frequency of activities and a brief description of the activity including routine details if possible *
Do you play any sports? Do you follow sports? Do you have a favourite sports team? *
List your favourite foods: *
List your disliked foods (if any) and food allergies/intolerances: *
Number of veggies consumed per day: *
Number of hours slept per night (indicate if you wake up at all during the night and how many times); also, how long does it take for you to fall asleep?: *
How stressed are you on average? *
As calm as a turtle
Pulling your hair out everyday (extremely stressed)
How often during the week can you commit to the gym? *
What days of the week work for you? *
Required
How much time do you have available to workout (in minutes) per workout? *
What equipment do you have access to? Will you be working out at a gym or at home? Please be specific and specify *
Required
Do you have a access to a gym? If yes, please state the address and email pictures if you can *
What exercises are you familiar with? *
Required
Do you have any issues performing any of the above exercises? *
Do you own a smartphone/ tablet? *
Do you have any special events coming up? Competition, birthday, vacation? When? *
What in life motivates you? It can be anything (role model to your favourite food to spending time with your children etc.) *
Short term: What would you like to accomplish within 8 weeks? *
Long term: What would you hope to accomplish in 16 weeks? *
On a scale of 1-10, how motivated are you in changing your lifestyle to achieve your goals? *
Not motivated at all
SUPER EXCITED, I'LL DO ANYTHING
Do you have any expectations regarding this coaching program? *
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