lets get started About You - General InformationYour Full Name(Required) First Last Gender Date of Birth(Required)Day12345678910111213141516171819202122232425262728293031Month123456789101112Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Height Starting Weight Hips & Waist (in cm)If Known How Can We Reach You?Mobile Best Time to Call YouSelect A TimeBetween 7am-9amBetween 9am-12pmBetween 12pm-3pmBetween 3pm-5pmYour Email Address(Required) Email Address Confirm Email Address Home Address Address: Suburb / City State Post Code Progress PicsNote: These can be uploaded into the Training app.Background InformationWhat is the primary reason you chose Total Sports Nutrition to help with your training & dieting goals?(Required)How did you hear about us? Are you currently seeing a physiotherapist or health care practitioner for any injuries or niggles?(Required)Are you seeing a psychologist for any mental health related issues?(Required)Are you seeing a Doctor for any health conditions or concerns?(Required)Are you currently on any medications?(Required)Are you currently taking any performance/health or enhancing supplements?(Required)(If so, please outline specific supplements you are taking and dosages)Goal SettingWhat is your primary goal?(Required)(Please outline in detail, and be as specific as possible)Why do you want to achieve this goal?(Required)(Reasons behind your goal and why its important to you)What limitations/obstacles are currently preventing you from achieving this?(Required)Do you have a time frame on when you wish to achieve this goal?(Required)What do you foresee to potential reasons for not reaching your goal?(Required)Are you willing to follow the advice/recommendations and guidelines proposed by your coach?(Required)(If no, please describe why not)Training HistoryHow many times a week are you willing to train? How long can you dedicate towards your training sessions? Do you have time constraints that will impact your training?(If yes, please outline) Do you currently have any injuries or niggles?(If yes, please list, describe and outline any health care practitioner you have seen regarding the matter) Have you previously had any injuries or niggles?(If yes, do these currently affect your training?) Are there any exercises you cannot perform?(If yes, please outline which exercise and why) Do you have access to a gym, resistance training equipment such as dumbbells, barbells etc?(Please name your gym if applicable. If no, please list the equipment you have access to) Please highlight your training experience:(If so, please provide attachment or details of current program) Have you previously followed a resistance training program?(If so, please provide details of current program) Please attached program or any related files if applicable.Max. file size: 5 MB.Please highlight your training experience:Beginner (1-2 years consistent/structured training)Intermediate (2-5 years of consistent/structured training)Advanced (5+ years of consistent/structured training)*It is important to note that in some more serious cases, it may be necessary to consult your Doctor to determine whether you will be fit and able to partake in training with Total Sports Nutrition.Training Video FootagePlease note: We will require you to submit videos of you doing various movements. We will outline the details of what is required after our initial review of your coaching questionnaire.Please rate your confidence in the gym on a scale of 1-10 (1 being no confidence, 10 being most confident)Are you performing any cardio? Do you play any sport or partake in any recreational exercise/activities outside of strength training?(If so, how many times a week, and does this affect your strength/resistance training?) Please select your preferred type of cardio training: Low intensity steady state Moderate intensity steady state High Intensity Interval Training Are you currently tracking your daily step count? (If so, please outline your average daily number of steps over 1 week)Diet HistoryHave you previously followed a diet?(If yes, please outline the specific diet, the duration and the changes in your bodyweight over this time)Do you know what calories/macronutrients are?(If yes, have you tracked your diet for more than 3 months?) Do you have any specific dietary requirements as recommended or prescribed by a dietician? Do you have any food allergies or intolerances that have been medically diagnosed?Please list your preferred food choices: Add RemovePlease list any foods you dislike: Add RemoveAre there any habits of behaviours preventing you from achieving your goals?(Please outline any habits of behaviours that are limiting factors in your diet/training)Do you eat out regularly?(If so, how many times per week and what foods do you choose?)Do you regularly do grocery shopping?(If so, how many times per week, and please outline your typical shopping list)Does your social life impact your ability to follow your diet?Please provide any detail.Do your partner, family and friends support your diet choices and goals?Please provide any detail.Do you regularly cook for yourself or others?Please provide any detail.Are you competent in the kitchen, and with prepping food?Please provide any detail.Have you previously had any eating or body image related issues, such as binge eating disorder?Please provide any detail.Lifestyle InformationWhat is your current occupation? Are you sedentary or active at work? How many hours sleep on average do you get each night? What is the primary lifestyle obstacle you face in achieving your goals? Do you drive or take public transport to work? Do you smoke? Do you take any recreational drugs?(If so, please outline the specific drug and frequency in which you consume it) Do you drink alcohol regularly?(If so, how much?) Thank You.We will get in touch with you soon, to review and discuss next steps.
