Thank-you

Thanks for choosing to work with me for your online coaching!

As mentioned in the sign-up page this training is Personalised to YOUR needs and will be designed to give you ALL the online coaching and support you need to get you to your goals.

Let’s get started!

Fill out the form below and I’ll contact you ASAP so we can get you started!

Client Details

Your Name (required)

Your DOB (required)

Contact Info

Your Email (required)

Your Phone/Mob

Your Address

House/Flat Number/Name (required)

Street (required)

Town/City

County

Postcode (required)

Why Online Coaching?

Indicate your reasons for choosing Online Coaching:

What are your main reasons for starting a fitness programme?

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?

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.

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

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

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)

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:

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

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:

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:

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:

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