Enter Interview

I really look forward to getting you in amazing shape and helping you to develop a super healthy lifestyle.

As per our conversation, please send me weight progressions every 2 weeks and photos once every 4 to 6 weeks. This is important and is one of the ways I can continue to calibrate your program as needed.

You can also e mail me anytime with questions:) I will get back with you usually on the same day but no later then 24 hours. I work Monday through Thursday from 8 am to 6 pm and Friday from 8 am to 3 pm. I am off on weekends. If you e mail me late on Friday I will get back with you on Monday.

If there is an emergency you are welcome to text me at the number provided on this page. I will get back with you asap.

Fitness Enter Interview Form

Welcome to the Healea method and Platinum Physiques coaching.

The following questions are designed for our coaches to properly assess your fitness goals. Please answer all questions as thoroughly as possible. Thank you!

Enter Your Name *

First Name Last Name

Do You Have A Coach? If So, What's His/Her Name?

Coach Name

How Did You Hear About Us?

Email *

example@example.com

Phone Number

Area Code Phone Number

In Case of Emergency

First Name Last Name

Phone # of emergency contact

Area Code Phone Number

Height

Weight

1. Please tell us specifically what you would like to see in your fitness goals? Example: I would like to be leaner, feel better, run faster, be stronger, more muscular. Bigger booty, smaller legs, bigger shoulders etc...

2. Are you going to compete in a fitness or other competition? Or, do you have an event you are getting ready for? Wedding, Vacation etc... If so what is the date or dates of the event?

3. Do you have any injuries or restrictions that would hinder your fitness goals? (A health history questionnaire will be added if you decide to hire platinum physiques).

4. How much time per week do you have to dedicate to your fitness goals?

5. On a scale of 1 to 10. 10 being the highest. What do you feel your current fitness level is?

6. Please describe your current fitness program. Example: I work out five days per week with weight training, boot camp, swimming, etc... And I do 4 days of hiking, treadmill, biking for one hour each.

7. Please describe your current food program. Please give us a good idea of what you eat every day on your normal food program.

8. What diet programs have you tried? And what diet programs have you done successfully? Which of these diet programs did you do exactly like they were designed?

9. Do you have any food restrictions such as allergies or other restrictions? Vegan, vegetarian, paleo?

10. Please list all medications.

Please list any current or past injuries and all surgeries

Is there any reason not mentioned why you should not follow a regular exercise program?

Name of Physician

Physician Phone:

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Enter Interview / Health History