Coaches New Consult Form

Coaches Consult Form

Client Name(Required)

First Last

Client's Email(Required)

( Please make sure to use the same email address here as you used earlier in the health form. )

3 complaints with health and wellness :-

Column 1

Column 2

Column 3

3 wants from the program :-

Column 1

Column 2

Column 3

What does the client want to ... ?

Suggested calories [ (goal body weightx 2.2 ) X 12 for fat loss or x 16 for fitness or x 18 for muscle gain ]

Carbs %

Protein %

Fat %

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Carbs (g)

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Protein (g)

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Fat (g)

First Meal(Required)

Suggestion / Recommendation

Second Meal(Required)

Suggestion / Recommendation

Third Meal(Required)

Suggestion / Recommendation

Fourth Meal

Suggestion / Recommendation

Fifth Meal

Suggestion / Recommendation

Pre consult meds/supplement :

Allergies

Food they like

Food they dislike

Do the client have any medical issue ?

Any medicine for the same ?

Supplements suggested by us :

What equipment do client have access to?

How many time a week will client be able to do a workout?

How long are they willing to work out?

Workout Program Recommendation

Ability to perform cardio exercises in time

Client's Profession

Steps Goal every day to be assigned

Habits to be added for stress to be added

Habits to be added for sleep to be added

Habits to be added for water to be added

Suggested start date(Required)

Comment (if any)

Get Client Data

Press Button to Fetch Client Health Form Data.

Name

DOB

Gender

What's your Instagram handle?

Fitness Goals :-

What are your main fitness goals?

What are some other health goals you have?

What is your activity level?

Workout preferences

What is your precise current weight? (As of today on an empty stomach) in kgs

What is your ideal long term weight goal? in kgs

How fast do you want to reach your goal? (approx. months)

Waist in cms?

Height in cms?

What is your approx. Body fat %?

Shoulder in cms?

Hips in cms?

Neck in cms?

Dietery Prefernces ?

Do you have any food allergies ?

What are your favourite foods ?

What are your least favourite foods or foods you avoid ?

Do you smoke?

Do you consume alcohol?

Blood tests image if uploaded. Link

Please upload any current prescriptions you have ?

Do you have Injuries / Surgeries/ Medical conditions?

Front Image Link

Side Image Link

Back Image Link

Mental & Emotional Health :-

How would you rate your current stress level ?

How offten do you have episodes of emotional eating or binge eating ?

What are your primary sources of stress? (Select all that apply)

What do you do to manage stress? (Select all that apply)

How would you rate your overall mood and mental well-being ?

How do you feel about your current body image ?

Coaches Consult Form

Fitness Goals :-

Mental & Emotional Health :-

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