Coaching Questionnaire

Name *

First

Last

Email *

Age *

Biological Sex *

Height (Inches) *

Weight (Lb's) *

Body Fat Percentage (If known)

What Aethix coaching service are you interested in? *

to ups/pull and

If other, please specify here

Average Daily Activity Level (1-5)

Selected Value: 1

Rate your average daily activity level from 1-5 with 1 being very sedentary, no current physical activity, sitting most of the day, with 5 being very active, regular, vigorous phsysical activity, physically demanding job and/or regular sports

Any relative medical conditions or medications that may effect training or nutrition goals? *

How many hours of sleep do you get per night on average? *

Rate your current level of stress from 0-10

Selected Value: 0

0 being completely stress free, 10 being chronically and uncontrollably stressed

Do you take any dietary supplements? If so, list them here.

Primary training goals *

Do you currently engage in resistance training and/or aerobic training? If so, how much time per week? *

Any specific muscles or lifts you'd like to improve the most?

How many days per week are you willing and able to exercise? *

How long (months, years) have you been seriously lifting/exercising for, if at all? *

Give a history of your past and current training. The more specific the better! *

Include exercises, weekly frequency, total volume (set and rep ranges), etc. Feel free to link specific program examples)

What are your best lifts (preferably 1 rep max, if known) for squat, bench press, deadlift, overhead press, and chin ups/pull ups? Feel free to include other lifts or rep ranges. *

List gym you go to and/or relevant training equipment you currently have access to. *

Do you have any existing injuries or difficulties performing certain lifts? *

What are your body composition goals? *

Specific dietary restrictions (For clients interested in nutrition/meal plan services)

Note: For nutrition/meal plans, Aethix only works with individuals willing to follow a plant based diet.

Current Average Daily Caloric Intake

Feel free to make an educated guess. If unknown, leave blank.

Current daily average macronutrient intake

Protein, fat and carb intake. Feel free to make an educated guess. If unknown, leave blank.

Do you own a food scale and if so, are you willing to regularly weigh and track your food intake?

Calorie counting and tracking is the most effective way to reach your body composition goals.

List any preferred foods/meals here (For clients interested in nutrition/meal plan services)

Feel free to include any additional notes, questions or comments here