Fitness Coach Form "*" indicates required fields Step 1 of 7 - Personal Information 0% Name* First Last Email* Enter Email Confirm Email Date of Birth*MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Choose preferred system of meausrement:*Metric for kilograms and centimeters. Imperial for feet, inches and pounds. Metric System Imperial System Height*Weight*Height*"* Weight*Body Fat Percentage I don't know 10%-20% 20%-30% Probably More than 30% More than 40% Do you have any existing injuries or physical limitations?* Lower Back Issues Knee Pain or Injuries Shoulder Problems None Other Please Specify:*What is your ideal weight or ideal physique?* Do you have any food allergies or intolerances?* Nuts Gluten Dairy Soy Other None Please Specify:*Are you currently taking any medications?* Yes, I am. No, I am not. Which?*Do you have any of the following conditions?* Diabetes High Blood Preassure Heart Condition Thyroid Issues None Other Which?*Do you normally take any supplements?* Yes, I do. No, I do not. Which?*Are you open to receive recommendations about weight loss/gain supplements?* Yes, why not. No, I would rather not. How would you describe your current eating habits?* Very healthy (mostly whole foods, minimal processed foods) Moderately healthy (balanced meals with occasional indulgences) Needs improvement (fast food, snacks, or irregular meals) Do you track your food intake?* Yes, I do sometimes. Not really. What do you track?* Calories Macros (protein, carbs, fat) Something else Which?*How many meals do you eat per day on average?*How many meals do you eat per day on average?12345+Do you follow any specific diet?*NoneKetoPaleoVeganVegetarianOtherWhich?*What foods you won't eat under any circumstance because they are too distasteful?*Don't forget to mention anything, this information is essential to build your new nutrition plan.On the other hand, which are your favorite foods? What is your current activity level?* SEDENTARY - Not working, not exercising. LIGHT - Light work or light exercise. MODERATE - Light work and light exercise. ACTIVE - Light work and intense exercise. Or very physical job. VERY ACTIVE - Everyday intense exercise. Or light exercise with physical job. EXTRA ACTIVE - Very intense exercise daily and physical job. What type of exercises do you prefer?* Cardio (running, cycling, swimming) Weightlifting or strength training Yoga or Pilates HIIT or circuit training Group classes Other Which?*Do you have access to a gym or equipment?* Yes, I have a gym nearby where I go or want to start going. Yes, I have equipment and normally workout at home. No, I don't have easy access to neither. What equipment do you own and/or use regularly?*How many hours can you dedicate to exercise weekly?*NoneLess than 3 hours3-5 hoursMore than 7 hoursWhat’s your current fitness level?* Beginner Intermediate Advanced Do you enjoy working out? Yes, I love it! Sometimes, depending on the day. Not really, but I do it anyway. No, I struggle with it. What motivates you to stay fit?* Health Appearance Energy levels Stress relief Other Which?*What are your biggest obstacles in staying consistent?* Lack of time Lack of motivation Confusion about what to do Cost Other Which?*Do you have experience with tracking your fitness progress? Yes No What do you track? Weight Measurements Progress photos Performance (e.g., strength gains) What’s your main goal with this fitness plan?*Be as specific as possible! E.g., “Lose 10 lbs in 3 months,” “Build lean muscle,” “Feel more energetic,” etc.Is there anything else we should know about you?Share any additional details that would help us customize your plan.Consent* I agree to the privacy policy.By submitting this form, you agree to the following: • I consent to the collection and use of my personal information for the purpose of creating a customized fitness and nutrition plan. • I understand that my data will be kept confidential and will not be shared with third parties without my explicit permission. • I agree to receive emails or communications related to my fitness plan and additional resources.Newsletter I would like to also receive emails about new video content, blog posts and health products from Healthy Women's Society.CAPTCHAPhoneThis field is for validation purposes and should be left unchanged.
