Client Questionnaire

Thank you for registering for our online coaching program with one of our elite trainers! Please review the info included on your trainers bio page before getting started, so you understand what is expected and included in your program.

We suggest that you check with your doctor before starting any new physical activity.

We also recommend you register a free account at www.myfitnesspal.com to keep track of your nutrition.

Please complete the form below to provide us with the information to help design your personalized program:

Your Name (required)
Your Email (required)
Phone Number
Your Date of Birth
Your Body Weight
Your Height (Feet, Inches)
Waist Measurement (at Belly Button)
Hip Measurement (widest point around glutes)
What are your primary training / fitness goals?
What is the name of the Trainer / Coach you have selected to train with?
Average Hours of Sleep Per Night
How long have you been strength training?
What are your primary physical activities or sports?
What type of work do you do? (ie: Mostly sitting, standing, walking, lifting? Schedule?)
Based on your schedule, how many days per week can you train / workout?
List and describe any injuries you have
List any other relevant health issues (ie: heart, blood pressure)
List and describe any exercises / movements you find uncomfortable or painful
How many full range bodyweight chin ups can you perform?
How many full range bodyweight parallel bar dips can you perform?
Where do you usually train (or plan on training)? Ie: fitness club, home gym, etc.
What exercise equipment do you have access to?
Attach Your Full Body Photo - Front (relaxed)
Full Body Photo - Side (relaxed)
Full Body Photo - Back (relaxed)
Briefly Describe Your Current Physical Exercise / Workout Routine
How many servings of fruits or vegetables do you eat daily?
How many servings of protein foods (ie: meat, fish, poultry, eggs, dairy) do you eat daily?
How many servings of carbohydrate foods (ie: potatoes, pasta, rice, bread, etc) do you eat daily?
Do you consume a source of healthy fat daily (ie: fish oil, nuts, avocado, olive oil)?
How many times do you eat daily?
Briefly Describe Your Current Nutrition Habits
Briefly List Your Food Preferences (Likes / Dislikes)
List Any Supplements you Take Regularly
Any Comments / Questions?
By clicking on the "Send" button below, you agree to release and forever discharge Your Gym Trainer, Josh Hewett, Steve Cairo, and your online coach (known herein as the ‘Releasees’) from any and all liabilities, claims, actions, damages, costs or expenses of any nature whatsoever, whether in law or equity, that you have ever had, or may have against any of the Releasees arising out of or in any way related, directly or indirectly, to participation in any of our online training programs and other related activities. You, the participant, agree to assume all risks incidental to such participation:
Yes, I AgreeNo