Consultation Form Consultation First NameLast NameGender Male FemaleHeightWeightTarget WeightPhone NumberEmailHow would you like me to contact you? Call Email Text (SMS)At what times during the day would you prefer a follow-up? Morning Mid-Day Afternoon EveningWhat do you do for a living?Do you follow a regular working schedule, do you work days, afternoon or nights?What is your Activity Level per Week? Inactive Moderate (1-2 hrs) Active (3 hrs) Very Active (4+ hrs)What are your Priorities? Lose Weight Lean and Tone Build Muscle Overall HealthPlease list the physical activities that you participate in outside of the gym and outside of work:If you have any diagnosed health problems list the condition(s):Are you experiencing any stress or motivation problems? Yes NoYour current diet could be best characterized as: low-fat low-carb high-protein Vegetarian/Vegan No special dietWhat is your goal with this program?What do you expect from me as your coach?How soon are you ready to Start? Today This Week Next Week Next MonthSubmit
