Your Name:*

Your Email:*

Date of Birth:*

Gender?:*
MaleFemale

Height (specify in inches or cms):*

Weight (specify in lbs or kg):*

1. Describe what are your short term (next couple of months) and long term (over a year) fitness goals:*

2. How did you find out about my Coaching Program?:*

3. Describe your early years as a child. Were you active? Into sports? Thin, normal or overweight? Etc:*

4. What are your biggest fears and frustrations with working out and getting in shape?:*

5. Are you currently working out?:*
Yes, I workout in a gymYes, I workout at homeI used to workout, but I've been off for a whileNo, I have never taken up a workout program.Other (please specify):

6. How long have you been working out? (skip if not applicable)

7. Which of the following facilities do you have access to?
Fully equipped commercial gymFully equipped home gymHome gym with a few essential pieces of equipmentSwimming PoolOutdoor track/field areaJoggers park

8. Which of the following equipments does your gym have?
Dumbells - upto 50lbsDumbbells - upto 80lbsDumbbells - upto 100lbsOlympic BarbellWeight plates - 45lbsWeight plates - 35lbsWeight plates - 25lbsWeight plates - 10lbsWeight plates - 5lbsWeight plates - 2.5lbsWeight plates - 1lbPower Rack/Squat RackSeated Leg CurlLying Leg CurlStanding Leg CurlHorizontal Leg PressStandard Leg Press (45 degree incline)Standing Calf RaiseSeated Calf RaiseTibia Raise (Tibia trainer)Adductor/Abductor machineDecline BenchIncline BenchFlat BenchPec fly/Rear delt fly machineLat Pulldown (single cable attached to bar)Lat Pulldown (dual cables attached to bar/handles)Seated Row machineSingle/Dual cable station (Functional tower, Multi functional station etc.)Cable Crossover stationDip stationPullup barAbdominal crunch machineBack extension station/machineGorilla Grip machineTreadmillElliptical/Crosstrainer machineStationary cycleRowing machine

9. What time of the day would you prefer to train?:*

10. Give me a detailed breakdown of your current workout schedule including the weekly split, the specific exercises, sets, reps etc of each workout, cardio and so on. :*

11. How much is the maximum time you can allot to exercise on my program? (Programs can be designed as long as you can spare the least amount of time mentioned here) :*
2 Hours a Day, Six Days a Week2 Hours a Day, Five Days a Week2 Hours a Day, Three Days a Week1 Hour a Day, Six Days a Week1 Hour a Day, Five Days a Week1 Hour a Day, Three Days a WeekOther (please specify):

12. Please describe your daily routine below along with the meals you eat.
For example:
06:00am: you wake up
06:30am: you have your breakfast of two boiled eggs, fresh fruit and a glass of milk.
09:00am: you leave for work

and so on...:*

13. For your nutrition plan, which of the following would you prefer?:*
Meal Plans: A structured meal plan with specific foods, quantities and timings for each mealMacro Targets: Only recieving macronutrient targets for each day (how many calories, protein, carbs and fat to eat) and you'll handle the meal planning yourself

14. (If selected "Meal Plan" above) Mention your food preferences in likes and dislikes for each of the following food groups:

Carbohydrates (eg. Rice, Pasta, All forms of Bread, Chapati/Roti, Oatmeal etc.)
Likes:
Dislikes:

Protein (eg. Meat, dairy, eggs, fish etc.)
Likes:
Dislikes:

Fat (eg. Nuts, Oils, Egg yolks, Cheese, Butter etc.)
Likes:
Dislikes:

Vegetables
Likes:
Dislikes:

Fruits
Likes:
Dislikes:

15. Have you ever had any injuries or are you currently facing one?:*

16. Are there any medical conditions you need to take care of? (Such as diabetes, hypertension, PCOS, etc)?:*

17. Any other health problems, allergies, strange issues, food dislikes and dietary restrictions (vegetarian/vegan)? List them all:*

18. Do you smoke or drink alcohol (if so how much & how often) ?:*

19. List any supplements and/or medications you are currently taking:*

20. Have you ever consulted a Personal Trainer or a Nutritionist or both?:*
Personal TrainerNutritionistBothNone

21. If you did, please describe your experience.
If the experience was good, what made you to not continue with them and come to me instead.
If the experience was not good, what do you feel was lacking and made you to not continue with them and come to me instead?:*

22. What are your expectations from this program (inches/kilos you want to lose/gain, dress size you want to fit into, improve sports performance etc.):*