NEW CLIENT QUESTIONNAIRE FORM

Personal Information

What's your full name? *

Personal Information

Date of birth *

Personal Information

Email *

Personal Information

Phone *

I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business.

Personal Information

Address? (in case we want to send you some gifts in the future ) *

Personal Information

What's your age? *

Personal Information

Gender *

Male

Female

Current Physical State

[MALE] Using the body fat percentage chart provided above as a reference, Make an honest assessment of your current body fat percentage. (Select the range that you feel most accurately represents your current state.) *

8-10% (Athletic Shape)

10-15% (In Good Shape)

15-20% (In "OK" Shape)

20-25% (Out of Shape)

25-30% (Extremely Out of Shape)

30-35% (Overweight)

35-40% (Dangerously Overweight)

40% and above (Obese)

Current Physical State

[W] Using the body fat percentage chart provided above as a reference, Make an honest assessment of your current body fat percentage. (Select the range that you feel most accurately represents your current state.) *

12-15%

15-20%

20-25%

25-30%

30-35%

35-40%

40-45%

45% and above

Current Physical State

Current Weight (empty stomach) *

Current Physical State

What's your height? (feet) *

Current Physical State

Do you have any diagnosed health problems or on any medications we should know about? *

Yes

No

Current Physical State

If you have any diagnosed health conditions, please list them below. Additionally, if you are currently taking any medications, kindly provide a list. *

Fitness Goals

In the next 12-16 weeks, what are your fitness goals? (Specify to the best of your ability) *

Fitness Goals

Picture yourself 1 to 2 years from now. Where do you see yourself? Describe your ideal physique, lifestyle, and mental state. *

Fitness Goals

Would you like to focus on specific areas of your body in your training program? If yes, please specify below. *

Lifestyle

On average, what is your level of daily activity? *

Sedentary : Spending most of the day sitting (e.g. bank teller, desk job)

Lightly Active: Spending a good part of the day on your feet

Active: Spending a good part of the day doing some physical activity

Very Active: Spending most of the day doing heavy physical activity

Lifestyle

How many days a week do you work? *

0-2

2-3

4-5

6-7

Lifestyle

How many hours do you work each day? *

4-6 Hours

6-8 Hours

8-10 Hours

10-12 Hours

12 Hours +

Lifestyle

On average you sleep how many hours per night? *

4-6 Hours

6-8 Hours

8-10 Hours +

Lifestyle

Rate your stress level on a scale of 1 – 5. (1 being calmest | 5 suffering badly) *

1

2

3

4

5

Lifestyle

What situations make you feel stressed? (IF ANY) *

Lifestyle

What type of health and fitness supplements are you currently taking or have previously taken before? *

Lifestyle

How much water including diet sodas are you drinking per day? *

Lifestyle

What form of exercise or hobbies you like to do in your spare time? *

List 3-5 habits you'd like to improve over the next 12-16 weeks. *

Lifestyle

Do you enjoy doing cardio? *

I enjoy cardio

I don't mind it, if it's not too long.

I'm willing to do whatever it takes

I F**** Hate Cardio

Nutrition

Which meal plan best fits your lifestyle, and you can adhere to consistently? *

Basic whole foods plan (includes both plant and animal-based protein)

Pescatarian Plan

Vegan / Plant Based

Nutrition

What's the number of meals you think you can consistently eat per day? *

2-3 Meals

3-4 Meals

4-5 Meals

Nutrition

List 5 to 10 foods that you enjoy eating and would like included in your meal plan. (no junk food) *

Nutrition

List any foods that you strongly dislike (without being too picky) or are allergic to and don't want to be included in your meal plan. *

Fitness Level

How many bodyweight squats can you do in 1-minute? *

BEGINNER: less than 20

INTERMEDIATE: 20 to 40

ADVANCED: more than 40

EXPERT: I'm no stranger to the gym

Fitness Level

How many push-ups can you do in 1-minute? *

BEGINNER: 20 or fewer

INTERMEDIATE: 20-30

ADVANCED: 40 - 50

EXPERT: 60+

Fitness Level

How long can you hold a plank? *

BEGINNER: 30 to 60 seconds.

INTERMEDIATE: 60 to 90 seconds

ADVANCED: 90 to 120 seconds

EXPERT: 120 seconds +

Fitness Level

How many burpees can you do in 1-minute? *

BEGINNER: 20 or fewer

INTERMEDIATE: 20 to 30

ADVANCED: 30 to 40

EXPERT: 50+

Workout Preferences

Where will your workouts take place? *

Commercial Gym

Home Gym

Workout Preferences

Provide a list of all the equipment you have access to at your Home Gym. (you can also email us a video of your workout space) *

Workout Preferences

How many days a week can you commit to working out consistently? *

2-3 Days per week

4-5 Days per week

6-7 Days per week

Workout Preferences

Select the days of the week you want to workout *

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Workout Preferences

How much time do you have to workout on these days? *

30-45 minutes

45-60 minutes

60-90 minutes

Injury Liability & Acknowledgement Agreement

I acknowledge that engaging in exercise and following the training program has an inherent risk of injury. I hereby assume full responsibility for any and all injuries, losses, and damages that I may incur while exercising or participating in the coaching program provide by Ramses Principe & Hyletics LLC. *

Agree

After submitting the form, you will be redirected to upload your 'before' photos.

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