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Online Personal Coaching - Consultation Form
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Full Name :
*
Your answer
Gender :
*
Male
Female
Email :
*
Your answer
Country :
*
Which country do you currently reside in?
Your answer
Which service are you most interested in?
*
Choose
Online Personal Training
Contest Prep Coaching
What are your current goals and expectations from this service?
*
Your answer
What have been some of the struggles you've faced with achieving this goal?
*
Your answer
How long have you been training in total?
*
(minus any extended periods of time off)
Your answer
Please describe your current activity level and type
*
(i.e. weights 3x week Push/Pull/Legs. Cardio - 3x week jogging HIIT etc)
Your answer
On a scale of 1-10 how happy are you with your current training and nutrition protocol?
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Hate it
1
2
3
4
5
6
7
8
9
10
Love it
On a scale of 1-10 how far along are you towards your goal?
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Not even close
1
2
3
4
5
6
7
8
9
10
Totally Satisfied
Is there anything at all you'd like to add which may help with your consultation/coaching?
Your answer
Would You Like a Skype or Phone Consultation to Discuss Your Custom Plan/Coaching?
*
Yes
No
Skype ID or Contact Number (if you answered "Yes" to the last question)
Your answer
Physical Activity Readiness Questionnaire (PAR-Q)
(Please answer the below questions as honestly as possible)
Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by your doctor?
*
Choose
No
Yes
Do you ever feel pain in your chest when exercising?
*
Choose
No
Yes
In the past month, have you ever felt pain in your chest when NOT exercising?
*
Choose
No
Yes
Do you lose your balance due to dizziness, or do you ever lose consciousness?
*
Choose
No
Yes
Do you have a bone or joint problem that could be made worse by physical activity? (i.e. back, knee, shoulder)
*
Choose
No
Yes
Is your doctor currently prescribing you drugs for a heart condition or blood pressure?
*
Choose
No
Yes
Do you have any other known injuries/allergies/illnesses that would affect your training/coaching?
Please be as detailed and as honest as possible
Your answer
Terms and Conditions
http://www.liftnlive.com/terms/
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I confirm that I have read, understood and accepted the terms and conditions outlined above
I accept the terms and conditions
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