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


    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)