Sweat Like A Pig Coaching Questionnaire
Part 1. Basic Information
Date of Birth
Part 2. Lifestyle Information
What do you do for a living?
What is the activity level at your job?
Moderate (light activity, such as walking)
High (heavy labor, very active)
What time of day do you typically work?
How often do you travel?
A few times a year
A few times a month
Please describe your current exercise regime (type, duration, frequency)?
How long have you been exercising for, if at all? How has your routine varied over the past few years compared to what you described above?
Do you have experience with weight lifting? Do you feel comfortable performing the major, compound lifts without supervision?
If applicable, what is your current best 1RM for the squat, deadlift, bench and overhead press?
How many calories per day do you eat, on average? (An estimate is fine.)
How has your caloric intake varied in the past? Have you ever gone through extensive periods of caloric restriction or suffered from an eating disorder? Have you ever suffered from binge eating? If so, please describe how often you binge/binged and what types of food typically make up a binge for you.
Do you have any food allergies or strong dietary preferences?
Please record all the food and drink you consume over the next three days. Include the exact portion sizes as well as the times you eat. Day One:
Part 3. Medical and General Health Information
If you have any diagnosed health problems, please list the condition(s).
If you are on any medications, please list them.
Have you ever had your hormone levels tested? If not, do you think there could be a problem?
How are your energy levels throughout the day, particularly during workouts? Do you have any sleep difficulties (such as problems falling asleep or staying asleep)?
How is your digestion? Do you experience any problems (bloating, constipation, etc) after consuming a high fat/carb meal (i.e. cheat meal)?
If applicable, do you have a regular menstrual cycle?
How is the quality of your hair, skin and nails?
Have you ever had any injuries? If yes, please list them and provide details if they are still causing problems.
Are you experiencing any stresses or motivational problems? If so, what?
How do you rate your current body image?
Part 4. Goals
Please rate your readiness for change.
What following goals best fit in with your goals?
Increased muscle mass
Improved body image
Better relationship with food
What is your biggest goal?
Do you have any other specific goals not mentioned above?
Do you have a timeline in mind to achieve your goals?
Have you tried to achieve these goals before?
Once or twice
Many times before
How many days per week are you able, and wanting, to go to the gym?
Please rate your motivational level to do what it takes for reach your goal.
Have you worked with a personal trainer before?
If yes, what kind of training did you do?
At what times during the day would you prefer to train?
What are your expectations for me as your coach?
All the information on this form is correct, to the best of my knowledge. I have sought and followed any necessary medical advice. I understand that all the information given will be kept confidential.
Should be Empty:
Now create your own JotForm - It's free!
Create your own JotForm