Premium COACHING INTAKE Maybe you hate forms (like me). The point of these questions is to understand where you currently are, where you'd like to be (in detail), and how you'd like to get there. The more detail you include, the more I can personalize the program for you. That will lead to the best results. PS I am asking for your mailing address so I can send a few things over that will help with your results.Name*Mailing Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Age*Height*Weight*Bodyfat estimate (and how you measured, dexa, weight scale, etc.)*Ideal Start Date*Years of lifting experience*Your GoalsWhat is your single biggest goal?*Be as specific as possible with your vision, and it helps to use real numbers in terms of changes. (You can even link to a photo of your ideal body or inspiration.)What do you think the main problem is?If you don't know—that's okay. But sometimes we might instinctively know when something keeps coming up in our life.Do you have any muscle groups you don't want bigger?*Tell us about yourselfWhat best describes you?*I don't have much time and/or energy, and I'd rather ease into the program, even if it means results will be slower.Improving my body is a priority of mine right now and I'm willing to adjust my lifestyle as needed to get proper results.I am willing to go "all in" with working out, diet, and lifestyle if it can speed up my results even just a little bit more (without jeopardizing health or taking drugs, of course).What do you do for work?*How would you describe your stress levels?*Low stress, like being on a beach on vacationOccasional but rare stress, like a student at the beginning of the semesterAverage stress, like a full-time jobHigh stress, great responsibility at work, young children, etc.Tell us about your sleep*How many hours do you sleep at night, what time do you go to bed, and do you "sleep in" on the weekend?How many daily steps do you estimate you get?*I don't know2,000–4,0005,000–7,0008,000–10,00011,000+What supplements do you take?Are you on any prescription medication?You don't need to answer this if you feel it is too private. But many prescription medications can cause muscle loss, stubborn fat gain, etc. and it could be helpful information as we work together.Working outWhat equipment do you have access to?You can skip this if you go to a public gym with everything you need (barbells, free weights, squat cages, etc.)Past Programs*What programs have you tried in the past? Did any program work particularly well? Did any program disagree with you?NutritionWhat do you feel gets in the way of your goals? Don't know what to eat Don't know how much to eat Lack of meals prepped No time to cook Don't know how to cook Not feeling hungry Always feeling hungry Anything we should know about your dietary preferences?*Allergies? Food intolerances? Any restrictions?Wrap-UpAnything else that you think we should know about?You can leave this blank if you think we've covered everything.Medical Release*This is pretty standard but it's important to bring up. You must take full responsibility for your health and your own needs. We aren't licenced medical professionals. This coaching cannot replace the advice of a medical professional. It is your responsibility to talk to a medical professional before, during, and after seeking coaching. So everything we provide is only information. By being coached, you agree to full responsibility for your decisions and to hold harmless Outlive, its employees, and any affiliate companies from liability with any injuries to you or your property with your use of any information discussed. I consent Δ This iframe contains the logic required to handle Ajax powered Gravity Forms.
