Name
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First Name
Last Name
Phone
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(###)
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####
Email
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What is your age and birthday?
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MM
DD
YYYY
What is your mailing address?
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Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
What is your current weight?
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What is your exercise experience level?
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If currently exercising, how long have you been exercising in a dedicated manner?
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If not currently exercising, how long have you been inactive for and what has been the cause of your inactivity?
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How many days a week can you commit to exercising?
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When is the last time that you exercised consistently for the amount of days written above?
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How much time/day do you have to dedicate towards your workouts?
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Hour
Minute
Second
AM
PM
What equipment do you have access to?
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List your top 2-3 favorite and least favorite exercises
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What makes the above your least favourite?
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What is your greatest struggle currently in regards to exercising (ex: time, lack of enjoyment, motivation, etc.)?
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What is one exercise you'd like to get better at performing and why?
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Please submit
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Once you have access to the training app, it is MANDATORY that you film yourself performing the following movements. At IHWGF, we provide video lift analysis, and it's important that a baseline of movement is provided before developing your program. These can be performed as bodyweight or with weight. All videos must be under 1 minute and will show you performing 3-5 repetitions, with a head-to-toe view, from both the front and side.
What is your history with dieting?
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What is your history with dieting? Please list all diets you have followed, when, for how long and the results you achieved. Please also list how long you maintained those results for.
Flexible Dieting is the nutrition style of coaching used at IHWGF. What is your experience with flexible dieting or macro counting?
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Have you ever used a calorie counter/macro tracking app such as MyFitnessPal?
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Do you consider yourself to be a yo-yo dieter?
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IE: do you have a history of going on strict/extreme diets, losing drastic (20+ lbs) amounts of weight in a short period of time and then gaining it all back and then some, and then repeating this process.
Do you have a history of disordered eating?
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This includes behaviours such as starvation, restriction, over-eating, over-indulging, binge eating, binge and purge cycle, labelling food as "good" and "bad", feeling guilt for eating certain things, emotional eating (eating out of happiness, sadness, anger, frustration)? If so, list which behaviours, for how long you've struggled with them and any actionable steps you have taken towards correcting them.
What are your top three favourite HEALTHY protein sources?
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What are your top three favourite HEALTHY carb sources?
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What are your top three favourite HEALTHY fat sources?
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How many meals and/or snacks are you regularly consuming?
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What time do you eat your first meal? What time do you finish your last meal?
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Before your starting nutrition goals are set for you, you will be asked to record one weeks' worth of regular eating. You will need to download MyFitnessPal, weigh and measure your food, then record it. MFP syncs with the training app and will allow me to get a gauge on where you currently eat and look for opportunity. Do you have any questions about this?
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You will need to purchase a digital food scale for measuring your food as it is more accurate than measuring cups and spoons. Do you have one or do you need a link provided to you to purchase one?
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How much water do you drink in a day? What other beverages are you drinking in a day? If you are drinking coffee & tea, what are you putting in it?
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Do you drink alcohol? If so, how often are you drinking? What are you drinking? What amount are you drinking?
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Are you committed to putting aside time for: grocery shopping & meal prepping weekly in order to hit your goals?
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Are you currently putting aside time for grocery shopping and meal prepping weekly? If not, what is the biggest barrier in not doing these tasks? (ie: lack of time)
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Your weekly check-ins are mandatory if you want to get the most out of your coaching experience. They will be submitted on the weekend and will include: taking pictures, taking measurements, weighing yourself on the scale and answering accountability and feedback questions. This is all done through the training app. Can you foresee any barriers that would prevent you from doing any of the actions listed? If so, which one and why?
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Do you get a regular menstrual cycle?
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Where are you currently at on your menstrual cycle?
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Are you on the birth control pill (oral contraceptive)? If yes, for how long and which brand?
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Do you suffer from PMS symptoms or PMDD? If so, please list symptoms and when you get them before your period and how long they last for?
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Are you post-partum, if so how long? (post partum is defined as having a baby who is less than 18 months old)
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Are you hoping to get pregnant in the near future? (near future is defined as 6-12 months)
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Are you pre or post menopausal? If so, which and for how long? If so, are you having any symptoms? Are you under any hormonal therapy? If so, please explain and also provide the name of the practitioner overseeing your treatment.
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Are you currently taking any supplements, undergoing HRT or prescribed medication? If so, please list below and dosage.
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On a scale of 1-10 how do you rate your current stress levels with 1 being non-stressed and 10 being completely overwhelmed and distressed.
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What are your top 3 health or fitness goals or the top habits you want to improve on or lifestyle changes you want to make?
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If applicable, how long have you been working towards your goals and what steps have you already taken on your own towards change?
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Why is now the time? What is creating urgency for you to now work harder than ever to hit your goals?
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Do you have a support system in place? If so, who is it and how do they support you?
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Often times people live with a spouse or children, on a scale of 1 to 10, with 1 being absolutely not to 10 being all in, how willing are they to make positive, healthy, lifestyle choices alongside you?
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What is the biggest thing that has held you back from achieving your goals on your own? Or what is the main driving force behind you wanting a coach in your corner?
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What motivates you the most to hit your goals?
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When is the last time you set a goal for yourself and achieved it? What was your goal?
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What is the top thing that can kill your motivation?
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What have you learned about yourself through previous experiences of working with a coach or trainer?
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What are you hoping to get out of our time together?
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What kind of communication style do you appreciate the most?
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Passive Cheerleader
Kind but Firm
Kind but Firm
Do you have any previous or current injuries that limit you in any movements? If so, what is the injury? When did it happen? What did you do for rehab? What movements do you feel it in? Does anything aggravate it, be specific.
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Do you or anyone in your immediate family suffer from or have experienced any of the following (family history of)?
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If you answered "yes" to any of the above, please elaborate below.
Do you have any other medical conditions or diseases not listed above? If yes, please elaborate below.
Please acknowledge that you understand that exercising is a risk and that you understand it is your obligation to seek the help of a medical professional to participate in an exercise program.
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Has your Dr ever said that you have a heart condition?
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Do you feel pain in your chest at rest, during your daily activities of living, OR when you do physical activity?
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Do you lose balance because of dizziness OR have you lost consciousness in the last 12 months? Please answer NO if your dizziness was associated with over-breathing (including during vigorous exercise).
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Have you ever been diagnosed with another chronic medical condition (other than heart disease or high blood pressure)? PLEASE LIST CONDITION(S) HERE:
