Online Coaching Client Questionnaire

PLEASE READ FIRST: Hi and thank-you for choosing TEAM CHERRY COACHING

Thank-you for wanting to do online coaching with us. Once you have selected which option you would like e.g. training only or training and nutrition or competition prep, I will set up a weekly debit on a day of your choice. Please complete all of the attached paperwork so I can get to know you better and so I can customise your food and training to suit your body composition goals.

In the section where it asks you about your food can you please give me lots of examples so I can give you as much variety as possible. Please include examples of meals you enjoy and a detailed list of food’s you do not enjoy.

You will receive a weekly check in. This will be done via email and your check-in day will be provided to you once sign up is complete. Please send me pictures in good lighting in bikinis or in bra/undies, undies or short shorts (men) - front, back and side every week on the chosen day – same time is preferable - along with the check in sheet (this is provided upon sign up). You will need to buy scales to record your body weight 3 times per week. You will put this in the weekly weight tracker which will give me the weekly average. Please complete all sections of the check-in sheet.

Food can be changed weekly in your check in e.g. you tell me what you feel like and I will adjust it/ make a new meal plan for you. I can only load one meal plan per 24hours so I usually get people to eat the same thing for 1 week before changing so I can see how your body reacts and adapts to the calories and macros given.

All food is to be weighed raw unless stated as cooked weight. If you use any supplements or have any food/s you love send me the name and the nutritional label so I can add them into my nutritional database. You can eat whatever you like as I follow a flexible dieting approach / calorie counting which means you can eat a wide variety of foods as long as you stay within your calories and macros.

Training: in the document attached please give me a detailed description of your current training regime, how often, how long, what you do e.g. weights vs' cardio, any movements you can't do and any movements you LOVE to do.

You will need to track your steps e.g. with a Fitbit, cheap tracker or another brand. I will get you to email me your daily steps in your check in e.g. mon - 10,000. Tues - 10,200 etc. I want you to start with 10,000. If you go over that awesome, if you go under that you will need to make them up on another day or on the weekend. Step targets are individual and will be given upon sign up.

Your Information

Name

First Last

Email

Mobile Number

DOB

Direct Debit Service

Account Name

BSB

Account Number

Day for funds to come out

Training Software

Height

Weight

Body Fat % (if known)

Do you have a dexta scan or bio-scan?

Yes
No

Upload Scan

Max. file size: 128 MB.

What you can comfortably Squat, Bench Press and Deadlift for 5 reps

Your current training split

E.g. Monday – Push. Tuesday – Pull etc.

Do you have any injuries that could affect your training

Any movements that cause you pain or discomfort

What gym do you go to

Nutrition

Do you have any allergies?

Do you currently track your food/ calories? Do you know your Macros? If so, what are they?

Do you know how to flexible diet?

What you like to eat for breakfast

What you like to eat for lunch

What you like to eat for dinner

Protein sources you like? E.g. chicken, beef, protein powder, etc.

Carb sources you like? E.g. rice, bread, pasta, oats, fruit etc.

Fat sources you like? E.g. avocado, nuts, olive oil etc.

Food you hate to eat?

Your current pre and post training meals

How many meals you eat per day

Metabolic Health Screening

What is your avg. sleep (hours) per night?

Please list any preferences you have for exercise selection

Do you have any injuries?

Yes
No

Please list your target & focus areas

How many litres of water/day do you drink?

How many days/week do you exercise?

Please rate the following statistics from 1 to 10

1: bad - 10: amazing

Current stress levels

Current ability to focus

Current memory ability

Energy levels - tired & sluggish

Current libido

Current relationship with food

Which best describes your approach to food currently?

Do you eat at least 1 serve of fruit and 3 serves of vegetables/day?

Yes
No

Do you drink more than 10 standard drinks of alcohol/wk?

Yes
No

Do you currently smoke?

Yes
No

Is your occupation sedentary?

Yes
No

History of yoyo dieting

Yes
No

Unexplained loss of muscle and body fat gain

Yes
No

Are you working toward a specific event or date?

Yes
No

Event Date

Have you been diagnosed with stress fractures, lower peak bone mass, osteoporosis or osteopenia?

Yes
No

Have you been diagnosed with anaemia, or low iron, b12 or folate?

Yes
No

Do you suffer from, or have you been diagnosed with heart disease, myocardial infarction (heart attack), atrial fibrillation, bypass graft, or valve replacement?

Yes
No

Have you been diagnosed with hypertension or high cholesterol?

Yes
No

Have you been diagnosed with type 1, type 2, or pre- diabetes?

Yes
No

Have you had any gastrointestinal surgeries within the last 12 months?

Yes
No

Do you suffer from, or have you been diagnosed with any food allergies or intolerances? (E.g. coeliac disease)

Yes
No

Have you been diagnosed with kidney disease, or reduced renal function

Yes
No

Have you been diagnosed with kidney disease, or reduced renal function?

Yes
No

Do you suffer from, or have you been diagnosed with an eating disorder? (anorexia, bulimia, purging, night eating syndrome, other)

Yes
No

Disclaimer

I acknowledge:*

- There will be a $99 joining fee that must be paid prior to coaching commencement
- a 12 x week minimum coaching period (free to cancel outside of this time-frame/once it has been completed)

I am fully aware of all risks associated with undertaking personal training, nutritional advice and supplementation and/or an exercise/training program with TEAM CHERRY COACHING. I understand, and am aware that exercise activities, personal training and Sports Nutrition, including those provided by TEAM CHERRY COACHING, may involve a risk of injury, including a remote risk of death or serious disability, and that I am voluntarily participating in these activities with full knowledge, understanding and appreciation of the dangers involved. I acknowledge and understand the nature and extent of these risks and recognize that it is my responsibility to seek medical advice as to whether I am able to participate in such exercise having regard to my age, level of fitness and overall health.

I agree to discharge TEAM CHERRY COACHING and their employees, servants or agents from all claims, or liabilities, injuries, loss or damage to my person and/or property, including those arising out of, or connected with undertaking any personal training and/or exercise/training programs provided by TEAM CHERRY COACHING including any claims or liabilities caused or contributed to by the negligence of TEAM CHERRY COACHING or any employee, servant or agent.

I acknowledge and confirm that the information I've entered is accurate

Name

First Last

Signature

Date