Getting to know you.

Help your coach learn more about you. You’re in this together, starting today.
Take this time for yourself.

This form should take about 3-5 minutes. Think of it as a part of your first coaching session – and an investment in yourself.

Note:Help your coach learn more about you,You're in this together, starting today.

1. Your Goals
 Lose Weight  Build muscle  Daily Activity  Support Perfomance
3.Get Control of your eating
4.Learn how to maintain your weight , perfomance , and/or habit after achieving your goal?
5. Your Scale
6. Current weight
7. If yoy had to select only one physical goals , which would you choose?
 I mostly want to lose fat , and I'm not connected with muscle gain.  I'd like to move better , lose some fat , and gain some strenth.  I .mostly want to build muscle ; I'm not concerned with fat loss
8. Please choose the statement that best matches your current exercise routine and needs.

Note: We are mainly looking to assess your exercise experience in a gym setting.

  I don't exercise much right now and have some difficulty with movement.   I have exercise experience and would prefer a home-based workout program.   I have exercise experience and would prefer a more gym-based workout program.
9.Do you currently have an injury, a movement limitation, or pain that limits your ability to exercise?

Please let us know if you have a current injury or any pain that impacts movement for you.

  Yes   No   If yes elaborate.
10. What's your biggest nutritional challenge?

Check all that apply.

  Cravings   Don’t know what I should eat   Eating out frequently   Eating quickly   Emotional eating / stress eating   Family / peer pressure   Large portions
  Lack of planning   Snacking when not hungry   Sweet tooth   Time to prepare meals   Wine / alcohol   Other
11. Number of meals a day?
  2   3   4   More
12. Which high protein foods do you like?
13. Which common vegetables do you like?
14. Which source of carbohydrates do you like?
15. Do you have any food allergies?
16. Which foods are you intolerant to?
17. Are you using any nutritional supplements?
  Yes   No
18. On an average day, how many glasses of water do you drink?
  3-5   5-8   8+
19. How many days a week do you exercise currently?
  2-3   3-5   5-7
20. Intensity of exercise?
  High   Moderate   Low
21. DOB:
  Male  Female   Other
23. Do you have a diagnosed health problem?
  Yes   No


24. Are you currently on any prescribed medication?
25. Are you receiving any treatment for your conditions?
26. How often do your drink alcohol?
  Daily  Regularly, few times a week   Occasionally   Rarely   Never
27. How often do you smoke cigarettes?
  Daily  Regularly, few times a week   Occasionally   Rarely   Never
28. How often do you take over-the-counter medication?
  Daily   Occasionally   Rarely   Never
29. Are you currently working?
  Yes   No
30. What do you do for a living?
31. How many hours do you work on most days?
  Fewer than 4 hours   4–6 hours   6–8 hours   8–10 hours   10–12 hours   12+ hours
32. What's your activity level at work?
  Inactive; I'm mostly sitting   Moderate; I'm on my feet for a part of every day   Active; I'm moving all day   Very active; I do physical labor
33. What is your typical stress level at work?
  Low stress; my work is pretty relaxed   Moderate stress; it's sometimes relaxed and sometimes crazy   High stress; I'm always under pressure