Online Coaching Application

DATE

HOW DID YOU HEAR ABOUT ME? (FRIEND, SEARCH ENGINE, ETC.)

Client Information

First Name

Last Name

End Section

Address

City

State

Zipcode

Email Address

Home #

Mobile #

Current Weight (lbs)

Goal Weight (lbs)

Height

Age

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Medical History

End Section

Past/Current Injuries (please include dates and detailed description)

Have You Gone Through Any Surgeries?

Yes

No

Specify (please include dates & detail description)

Have You Been Medically Cleared By Your Physician To Exercise?

Yes

No

Physician's Name

Physician's Contact #

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Fitness Information

End Section

Equipment You Have Available

Times Per Week You Can Train

Top 3 Fitness Goals

3 Areas You Feel That Needs Improvement

Activity Level (1-light, 2-moderate, 3-heavy)

1

2

3

List Your Current Training Plan For The Last 8-12 Weeks (please by honest)

List Your Current Diet (please be honest)

Current Occupation & Hours (include time spent sitting)

please list any additional information you feel I need to be aware of and why you would like to train with me.

I have been honest in providing the following information to the best of my knowledge.

Yes

Kristy's Online Coaching

Client Information

Medical History

Fitness Information