Fitness Coaching Care Plan Form
Please complete this form to help us design a personalized fitness coaching plan tailored to your needs, goals, and health background.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact Name and Phone Number
*
Date of Birth
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Do you have any existing medical conditions or injuries?
*
No
Yes (please specify below)
If yes, please describe your medical conditions or injuries.
Are you currently taking any medications?
*
No
Yes (please specify below)
If yes, please list your current medications.
What are your primary fitness goals? (Select all that apply)
*
Weight loss
Muscle gain
Increase endurance
Improve flexibility
Rehabilitation
General health
Other
Describe your current physical activity or exercise routine.
*
How many days per week are you available for coaching sessions?
*
Please Select
1 day
2 days
3 days
4 days
5 days
6 days
7 days
Preferred days/times for coaching sessions
Please rate the following lifestyle habits
*
Rows
Poor
Average
Good
Excellent
Nutrition
1
2
3
4
Sleep quality
5
6
7
8
Stress management
9
10
11
12
Hydration
13
14
15
16
Do you have any exercise preferences or restrictions we should know about?
Signature (please sign below to confirm your consent and understanding)
*
Submit Care Plan Form
Submit Care Plan Form
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