coaching application name * First Name Last Name email * phone * Country (###) ### #### when were you born? * MM DD YYYY which city do you live in? * what languages do you speak fluently? * select all that apply english arabic french what are your long term goals? * what are your expectations from our sessions? * what are your ideal days & times that you'd like to train? how frequently per week? * why is now the right time to start working towards your objectives? * how physically active are you right now? how often do you move a week? * 0 hours 1 hour 2 hours 3 hours 4 hours 5 hours >5 hours a week what type of exercise do you currently do? * are you following a specific diet? * yes or no (if yes, please explain) are you experiencing or ever experienced any of these? * no cancer pregnant dizziness/fainting migraine/headaches high blood cholesterol high/low blood pressure skin (eczema, psoriasis...) vision (cataract, glaucoma...) allergies (food, medication...) kidney (stones, failure, infection...) metabolic (pre-diabetes, type 1 or 2) bone (osteoporosis, osteoarthritis...) digestive (hernia, heartburn, ulcers...) inflammatory (psoriasis, arthritis, lupus...) mental (depression, anxiety, bipolar...) breathing (asthma, emphysema, pneumonia...) hormonal (hypo/hyper-thyroidism, PCOS, menopause...) neurological (epilepsy, stroke, parkinson's, multiple sclerosis...) heart or cardiovascular (infarction, angina, murmur, heart failure...) other (explain in message below) specify any medication(s) or supplement(s) you are taking now. why? * has a doctor suggested you to avoid any physical activity in the past or present? why? * indicate any & every past major trauma or accident (fracture, sprain, car accident...) please specify the date & what intervention has been done following the event: * how did you hear about me? * instagram tiktok mentorship program other (explain below) anything else you want me to know? Thank you! I will reach back out to you as soon as possible!
