Online Coaching Questionnaire

    Client Details


    Contact Info


    Your Address





    Why Online Coaching?

    Indicate your reasons for choosing Online Coaching:

    What are your main reasons for starting a fitness programme?

    General Conditioning YesNo
    Muscular Strength YesNo
    Physical Appearance YesNo
    Weight/Fat Loss YesNo
    Aerobic Fitess YesNo
    Improve Self-esteem YesNo
    Stress Management YesNo
    Flexibility YesNo
    Other? Please give further info:

    How would you describe your current general health and fitness?
    Very badBadAverage UntrainedAverage TrainedTrainedGoodAthlete

    Have you done any structured exercise before?
    YesNo

    If yes, what did you do?

    What did you enjoy the most?

    What did you dislike / least enjoy?

    What did you find easy?

    What did you find most challenging?

    What would you say are the main barriers to you from structuring your exercise plan?

    Lack of facilities YesNo
    No motivation YesNo
    No Time YesNo
    Injury/Illness YesNo
    Unfit YesNo
    Appearance YesNo
    Lack of Knowledge YesNo
    Family YesNo
    Work YesNo
    Other? Please give further info:

    Workout Planning Information

    How many sessions are you willing to commit to a week?

    Home Sessions | Gym Sessions

    If doing gym sessions, please state which gym:

    Roughly how long to do you want each training session to be?
    mins

    Are you planning to do any other exercise outside of this workout plan?
    YesNo

    If yes, please give as much detail as you can (day, time, duration and type of exercise - i.e. circuit class, outdoor run, treadmill session, spin class)

    Access to Equipment

    At Home At Gym
    Type Experience Level Have access to Willing to use Have access to Willing to use
    Treadmill
    CrossTrainer
    Stationary Bike
    Rower
    Stepper
    SkiErg
    Stair Master
    Resistance Machines
    TRX/Suspension
    Kettlebells
    Power Bags
    Dumbells
    Barbells
    Medicine Balls
    Plyo Box/Step

    Please list any other equipment you have access to:

    Medical History

    You should check with your doctor before you significantly change your physical activity patterns. If you are over 69 years of age and are not used to being very active, check with your doctor.

    Please read each question carefully and answer honestly by indicating YES or NO.

    Have you had a major illness or injury in the last 5 years? YesNo - If yes, please give details:
    Are you receiving treatment for any diagnosed medical condition? YesNo - If yes, please give details:
    Are you taking any prescription medication? YesNo - If yes, please give details:
    Do you ever get unusually short of breath with very light exertion? YesNo
    Do you ever have pain, pressure, heaviness or tightness in the chest area? YesNo
    Do you regularly have unexplained pain in the abdomen, shoulders or arm? YesNo
    Do you know of any other reason why you should not take part in physical activity? YesNo

    Please indicate if you have ever experienced any of the following symptoms/
    Do you:

    Ever have severe dizzy spells or episodes of fainting? YesNo
    Regularly get lower leg pain during walking that is relieved by rest? YesNo
    Are you taking any prescription medication? YesNo - If yes, please give details:
    Ever experience palpitations or irregular heartbeats? YesNo
    Are you currently pregnant or have you given birth in the last 6 months? YesNo
    Do you experience aches, pains and problems in any specific areas:
    e.g. "I always get knee pain when running"    		 YesNo - If yes, please give details:

    Client Declaration:

    I understand that when undertaking a new exercise regime I need to ensure I am physically fit and that I should check with my doctor first if I answer yes to any of the following questions

    Has your doctor ever said you have a heart condition and that you should only do physical activity recommended by a doctor? YesNo
    Do you feel pain in your chest when you do physical activity? YesNo
    In the past month, have you had a chest pain when you were not doing physical activity? YesNo
    Do you lose balance because of dizziness or do you ever lose consciousness? YesNo
    Do you have a bone or joint problem ( for example back, knee or hip) that could be made worse by a change in your physical activity? YesNo
    Is your doctor currently prescribing medication for your blood pressure or heart condition? YesNo
    Do you know of any other reason why you should not take part in physical activity? YesNo
    If YES Please further info:
    I confirm that I have answered all questions honestly & the information given is correct.
    I confirm that I am voluntarily engaging in an acceptable level of exercise, and my participation involves a risk of injury
    I understand that by submitting this form I am committing to paying for and undertaking Online Coaching provided by Forza Fitness and that no plan will be released until my payment has been received.

    Sign (Please type name/initials): (required)

    Date Signed: (required)

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