CLIENT APPLICATION

The following application will help determine your level of readiness to make lifestyle changes, your motivation towards reaching your goals, and identifying obstacles to your success. There is no right or wrong answers as this information will be used in the development of the best possible program for you.

ALL fields with an (*) are required.

GENERAL INFORMATION





If applicable, you'll be asked to send a copy of your valid military or student ID.

BIOMETRIC INFORMATION


GOALS

1. What are your short-term goals? (0-6 month timeframe)*

2. What are your long-term goals? (6+ month timeframe)*

3. What are areas you would like to improve on? (e.g. body-parts, exercise movements, etc.)*

4. Is there an event you're training for (e.g. fitness competition, marathon/5k, obstacle run, etc.)? YesNo

a. If you answered "Yes" to Question 4, please explain:

5. On a scale of 1-5, currently, how motivated are you to change your lifestyle and achieve your goal(s)?*

RESISTANCE TRAINING

1. How many days do you perform resistance (weight) training per week?*
2. What's the average duration of these workouts?

3. What is your current resistance training routine/split/regimen?

4. Realistically, how many days per week can you commit to a resistance training program?*
5. Based on your response to Question 4, realistically, how much time can you commit to each resistance training workout?

5. If you answered "None" to Question 4, please explain:

6. Based on your answers to Questions 1-5, are you open and willing to make modifications, if needed, to achieve your desired results/goals? YesNo

a. If you answered "No" to Question 6, please explain:

CARDIO

1. How many days do you perform cardio per week?*
2. What's the average duration of these cardio sessions?*

3. Which method(s) of cardio do you perform: (Check all that apply) LISS (Low Intensity Steady State)MISS (Moderate Intensity Steady State)HIIT (High Intensity Interval Training)Other
a. If you chose "Other" for Question 3, please explain:

4. Realistically, how many days per week can you commit to a cardio program?*
5. Realistically, how much time can you commit to each cardio session?

5. If you answered "None" to Question 4, please explain:

6. Based on your answers to Questions 1-5, are you open and willing to make modifications, if needed, to achieve your desired results/goals? YesNo

a. If you answered "No" to Question 6, please explain:

NUTRITION

1. Have you ever dieted before? YesNo

a. If you answered "Yes" to Question 1, which diet did you follow and/or what did it consist of?
b. Did you get results from this diet, and was it sustainable long-term?

2. Have you ever done a reverse diet before? YesNo

a. If you answered "Yes" to Question 2, what did it consist of?

3. Have you ever tracked macronutrients (protein/carbs/fat) before? YesNo

4. Describe your current nutrition intake. Include total calories, carbs, protein, and fats. If unknown, list your food intake (amount and type) for a typical day:*

5. How would you rate your eating habits and understanding of nutrition as it relates to your goals?*

6. Do you currently take any supplements? YesNo

a. If you answered "Yes" to Question 6, please list:

7. Do you have any allergies (food, supplement, medication), diseases or disorders? YesNo

a. If you answered "Yes" to Question 7, please list:

MEDICAL HISTORY

1. Do you have any medical conditions? (e.g. Type II Diabetes, Hypertension, etc.) YesNo

If you answered "Yes" to Question 1, please list:

*If selected to work together, additional medical history information will be asked, and a liability waiver will need to be accepted.

OTHER

Financially, I...
have the resources to invest in my health, fitness and nutrition.have access to the resources to invest in my health, fitness and nutrition.don't have any resources at all and I'm going to keep my health, fitness and nutrition exactly where it's at.


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Jon McQueen
Carlsbad Fitness Studio

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