Leia Nicole Fitness Customized

Personal Training Application

CONGRATS on taking ACTION towards reaching your goals!

The first step is to complete this form and hit SUBMIT at the bottom.

I will get back to you shortly to discuss in detail if we would be a good fit and how I can help you step by step toward achieving your health and fitness goals!

First name

Last name

Address

Phone

Date of birth

Month

Day

Year

Occupation

Instagram username (if applicable)

Age/Height/Weight

How many calories are you currently eating a day? Please include also how many grams of carbs/fats/protein you’re getting. If you are not sure, are you willing to track your food in My Fitness Pal for a week before we start a program?

What TYPES of foods do you usually eat every day (what does a typical day look like)

Have you been gaining, maintaining or losing weight over the last 3-6 months?

What have you been doing for cardio exercise the past 6 months? Please be specific(how many days a week, how long are your sessions, are you doing HIIT or walking or running, etc)

Are you taking any medications or under the care of a physician for anything? If so, please describe:

What supplements are you currently taking?

What areas of your body/trouble spots do you want to focus on?

What do you like/enjoy about exercise, and what do you dislike?

How active are you outside of the gym? (are you highly active, are you in any sports, do you have a sedentary job, etc) What do you do for a living?

When was the last time you stuck to a diet? Did you see results? If no, why do you think that is?

Have you ever done a fitness program before? (like a weekly class, go to the gym, see a trainer, or use workout DVDs like P90x, etc) if so, what did you do and for how long?

Have you ever seen results from a workout program? If no, why do you think you didn’t see or maintain those results?

What do you feel you struggle with when it comes to diet and exercise? (can't find the motivation, it's too hard, don't know where to start, struggle with emotional eating/forgetting to eat, etc)

Do you ever have any chest pain, trouble breathing, knee pain, joint or muscle pain?

What are your short term goals?

What are your long term goals?

Do you have a history of eating disorders or restrictive eating?

How would you rate your overall digestion? Please list any current or past issues.

Do you understand that everyone's body is different, and it may take some time and patience to start seeing results?

How many alcoholic drinks do you have a week? Do you smoke?

How comfortable do you feel performing strength training exercises with weights?(be specific with how much experience you have, how heavy you have lifted in the past, etc)

How comfortable do you feel with HIIT (high intensity interval training) and cardio type exercises?

Please list and describe any injuries or things I need to be aware of when I am designing your program.

Would you like workouts for at home, at the gym or both? If at home, please also list what equipment you have available to you.

Please list how many days you will REALISTICALLY workout a week (not how many days you wish you could workout) and the amount of time you can dedicate to each session.

What is your reason, your WHY for wanting to start a fitness program? What kind of results would you like to see? (example: fat loss, tighten and tone, become healthier overall, learn how to maintain a healthy weight, increase confidence etc)

Are you ready to commit to keeping a food log, making lifestyle changes, and being consistent with checking in with your coach weekly? Rate your readiness on a scale of 1-10, with 10 being “I am ALL IN" and 1 being "Not sure why I am even applying"

What is your timeline for achieving your goal? (12 weeks, 16 weeks, 24 weeks, 32 weeks, 40 weeks, 1 year)

What are your expectations of ME as your personal trainer and coach?

Which days of the week are the best days for you to workout? And what time... Morning, afternoons or evenings?

Is there anything else you would like to tell me?

Please upload a photo of yourself so I can get an idea of your body type

Todays Date

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I declare that the info I’ve provided is accurate and complete.

Gift Cards

Leia Nicole Fitness Customized

Personal Training Application

1 Peter 4:10- Each of you should use whatever gifts you have received to serve others, as faithful stewards of God's grace in its various forms.
- Our Mission Verse

Gift Cards

Leia Nicole Fitness Customized

Personal Training Application

1 Peter 4:10- Each of you should use whatever gifts you have received to serve others, as faithful stewards of God's grace in its various forms. - Our Mission Verse

1 Peter 4:10- Each of you should use whatever gifts you have received to serve others, as faithful stewards of God's grace in its various forms.
- Our Mission Verse