Coaching Baseline Data

Coaching Baseline Data

We just ask for a few baseline details that will help you on your journey

Your Name*

( First and Last name)

Your Email*

Physical Fitness History

Please give a brief explanation of your history with physical fitness

You're almost there

We just need a few details before we move on. These will help to calculate your BMI and give a little insight of your current body state

Date of Measurement*

What dates are the below measurements accurate?

P.S. it doesn't need to be perfect

Your Current Height*

Measure in inches please

Select

Your Current Weight*

Measure in lbs.

Select

Gender*

(gender at birth)

Male

Female

Current Weekly Activity Range*

What has been typical for you?

Sedentary: little or no exercise

Light: exercise 1-3 times/week

Moderate: exercise 4-5 times/week

Active: daily exercise or intense exercise 3-4 times/week

Very Active: intense exercise 6-7 times/week

Extra Active: very intense exercise daily, or physical job

Active Time a Week

How much time a week can you dedicate to your physical fitness?

Less than 1 hour

1-2 hours

2-5 hours

6-7 hours

7+ hours

If you know these details, enter them below

If you don't have these numbers, you are all set to move on to the next step.

Describe any dietary needs or restrictions you adhere to

Weekly Caloric Intake

Estimate

Average Daily Caloric Intake

Estimate

How were you made?

These next few questions give us some more understanding about your background and what made you who you are today. If you can, please answer these and you will be all finished.

Do you have any siblings?*

Select

Which Birth Order Describes you best

This doesn't need to be perfect

First Born (Oldest child in the near age group)

Middle Child

Youngest Child

I don't know how to answer

Have you ever taken a D.I.S.C. personality assessment before?*

Yes

What is your DISC personality type?

This is the highest score

Dominance (D) – Direct, decisive, results-driven

Influence (I) – Social, persuasive, enthusiastic

Steadiness (S) – Patient, loyal, team-oriented

Conscientiousness (C) – Analytical, detail-oriented, precise

Not Sure / Haven't Taken It

How many times in your life have you moved?*

an estimate is okay, this can be homes, cities, or states

Select

What is your Profession*

What to do you for work? If its multiple things, list them all

Submit your form below

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