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Programs
Online Personal Training & Nutrition
90 Day Habit Transformation Coaching
About
FAQ
Books
90 Day Habit Transformation Book
10 Inspirational Fitness Short Stories
Blog
Appointments
Physical Activity Readiness Questionnaire
Step
1
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9
- ___Basic Info___
11%
Hidden
Coach Query String
Name
(Required)
First
Last
Email
(Required)
PLEASE USE THE EXACT EMAIL YOU USED WHEN PURCHASING YOUR TRAINING PROGRAM
Emergency Contact Name
(Required)
First
Last
Emergency Contact Phone
(Required)
Age
(Required)
Gender
(Required)
Male
Female
Height (In Inches)
(Required)
Current Weight (lbs)
(Required)
Primary Goal
(Required)
Lose Weight
Body Recomposition - Maintain Weight
Build Muscle
What is Your Short-Term Fitness Goal? (30-90 Days)
(Required)
What is Your Mid-Term Fitness Goal? (90-180 Days)
(Required)
What is Your Long-Term Fitness Goal? (180 + Days)
(Required)
Rate The Level Of Accountability You Prefer
(Required)
1 - Very little Accountability Needed. (Just occasional check-ins and words of encouragement.)
2 - Moderate Level of Accountability is Needed (Don't let me get away with skipping workouts or check-in calls.)
3 - High Level of Accountability Needed (Frequent messages, don't allow skipped workouts and do not accept excuses!)
Please Select A Coach
(Required)
Milly
Please Select A Coach
(Required)
Milly
Tate
Please Select A Coach
(Required)
Milly
Tate
Cameron
Please Select A Coach
(Required)
Milly
Cameron
Please Select A Coach
(Required)
Tate
Please Select A Coach
(Required)
Tate
Cameron
Please Select A Coach
(Required)
Cameron
Please Select A Coach
(Required)
Sammy
Please Select A Coach
(Required)
Cameron
Sammy
Please Select A Coach
(Required)
Tate
Cameron
Sammy
Please Select A Coach
(Required)
Milly
Tate
Cameron
Sammy
Please Select A Coach
(Required)
Tate
Sammy
Please Select A Coach
(Required)
Milly
Tate
Sammy
Please Select A Coach
(Required)
Milly
Cameron
Sammy
Please Select A Coach
(Required)
Milly
Sammy
Physical Readiness
Please Check All That Apply. If None, Click "Next" On The Bottom Left.
Has your doctor ever said that you have a heart condition and that you should limit activity?
Do you feel pain in your chest when you do physical activity?
In the past month, have you had chest pain when you were not doing physical activity?
Do you lose your balance because of dizziness or do you ever lose consciousness?
Do you have a bone or joint problem that could be made worse by a change in your physical activity?
Is your doctor currently prescribing drugs for your blood pressure or heart condition?
Medical Condition. Please Check All That Apply. If None, Click "Next" On The Bottom Left.
Heart Condition
Asthma-uncontrolled
Shortness of Breath
Arthritis Bursitis
Osteoarthritis
Rheumatism
Hernia
Recent Surgery
Sacroiliac Problems
Angina
High Blood Pressure
Knee Problems
Back Problems
What Are Your Current Medications?
Do You Have Any Injuries That Affect Exercise?
Describe your occupation and typical workday
(Required)
How Many Hours Each Day Do You Sit?
(Required)
Less Than 1 Hour
2 - 4 Hours
4 - 6 Hours
More Than 6 Hours
What Kind of Shoes Do You Wear Most Often?
(Required)
Flat Shoes
Athletic Shoes
Mid-Heel Dress Shoes
High Heels / Heeled Boots
How Would You Rate The Stress Level Of Your Job?
(Required)
1 - Not Stressful
2 - Moderatly Stressful
3 - Short Periods of High Stress
4 - Long Periods of High Stress
5 - Stress In a Constant Potential Life Threatening Environment
What, If Any, Are Your Hobbies?
Personal Fitness Goals
(Required)
Appearance (Aesthetics)
Cardiovascular endurance
Flexibility
Health (General)
Muscular definition
Muscular size (Hypertrophy)
Muscular strength/power
Speed & Agility
Self-esteem or confidence
Sports specific training
Stress reduction
Fat loss (Weight loss)
Corrective exercise (Post-rehabilitation)
Other fitness goals or desires not indicated above
Athletics, Sports & Recreation
In this section, please share the sport or recreational activities in which you participate. If you are an advanced athlete and require or desire sports specific training or corrective exercise please explain your needs in the “Additional Details” section at the bottom of this page. If you are not necessarily an advanced athlete but would like to participate in one of the Sport's below please indicate your desire in the “Additional Detail” section at the bottom of the page.
American Football
Baseball
Basketball
Ice Hockey
Soccer
Tennis
Golf
MMA or Wrestling
Marathon Athlete
Triathlon Athlete
Hiking - Back Country
Oar or Paddle Boating
Tough Mudder, Spartan or Other Hybrid Event
3,k, 5k or 10k Runs (Leisure or Competitive)
Any Other Sport or Activity Not Listed:
Additional Details - Please Specify Needs Related to Your Sport
Please describe your current activity or workouts
(Required)
Rate your experience with exercise
(Required)
Beginner
Intermediate
Advanced
Competitor
Rate your overall activity level
(Required)
Sedentary
Moderately active
Active
Very Active
Competitor
Rate your ability to perform cardio exercises
(Required)
Very low
Fair
Average
Good
Competitor
What form of cardio do you like best?
(Required)
Running - Outside
Walking - Outside
Running - Treadmill
Walking - Treadmill
Elliptical Trainer
Stationary Bike
Recumbent Bike
Stair Climber
Other
How Would Your Rate The Quality of Your Nutrition?
(Required)
Very Poor (Fast Food, Microwave Meals, Soda, or Sweets)
Poor (Some Fast Food, Occasional Microwave Meals, Soda, and sweets)
Average (Rarely eat Fast Food or Microwave Meals, Occasional Soda and Sweets)
Mildly Healthy (Almost No Fast Food or Microwave Meals. Rare Soda or Sweets)
Healthy (No Fast Food or Microwave Meals. No Sods and Rare Sweets)
How Many Alcoholic Beverages Do You Consume Weekly?
(Required)
None
1-3
3-6
6 or more
What equipment do you have access to?
(Required)
Free weights (dumbbell/barbells)
Gym machines (Freemotion, Precor, Cybex, etc.)
Cable machines
Resistance bands
Bosu ball
Stability ball
Kettlebells
Suspension training (TRX)
Bowflex or other home gym
No equipment
Please Check All That Apply
Please Describe Your Training Enviroment
(Required)
Dietary Preferences
(Required)
Balanced
Gluten-free
Lactose-free
Plant-based
What Days Do You Plan To Work Out
(Required)
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
How Frequently Do You Expect To Exercise
(Required)
1 - 3 days each week
4 - 5 days each week
6 - 7 days each week
I plan to follow my trainers recommendation
Is there anything else you would like your trainer to know?
