Coach MP New Client Form
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Name
*
First Name
Last Name
Email
*
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
I am interested in coaching for:
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Lifestyle Client
Bikini Competitor
Figure Competitor
Macros Only Client
Height
*
i.e. 5'3
Current Weight
*
Please list in pounds
Age
*
Are you willing to make permanent lifestyle changes to reach your health and fitness goals?
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Yes
No
What are your long term physique goals?
*
i.e. lose fat, gain muscle, find balance, etc.
Have you ever had an eating disorder (diagnosed or undiagnosed)? If so, please explain.
*
Do you currently practice flexible dieting/IIFYM?
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Yes
No
I have never heard of flexible dieting or IIFYM
What does a typical day of eating look like for you? Please give examples of what you eat daily for each meal.
*
Do you currently workout? If so, what types of workouts do you do?
*
How often do you workout?
*
Everyday
5-6 days per week
3-5 days per week
1-2 days per week
I do not workout at all
Where will you be doing your workouts?
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Gold's Gym
Planet Fitness
Club Fitness
Anytime Fitness
Small local gym
Home gym (full access)
Home gym (limited access)
Do you have any physical limitations that would not allow you to do certain exercises?
*
Are you currently taking any medicine and/or supplements? If so, please list below.
*
Does your significant other FULLY support your decision to make a lifestyle change?
*
Yes
No
We have not talked about it.
Please upload current full body pictures in bikini, sports bra and shorts or bra and undies.
Browse Files
Pictures should be taken head to toe.
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Is there anything else you'd like to share with me before starting your fitness journey?
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