Client Questionnaire

Please begin by filling out the following Online Training & Nutrition Questionnaire. Do your best to provide as much information as possible – the more I know about your current habits, the better I can partner with you to reach your goals.

Please feel free to contact me ahead of time with any concerns/comments.

Fields marked with are required.

PERSONAL INFORMATION

FIRST NAME

LAST NAME

AGE

EMAIL

PHONE NUMBER

FACEBOOK URL

INSTAGRAM USERNAME

CITY

STATE

HEIGHT

WEIGHT

DATE OF BIRTH

GENDER


HEALTH & NUTRITION

MEDICAL CONCERNS

MEDICATIONS

VITAMINS OR SUPPLEMENTS

FOOD ALLERGIES

FOOD INTOLERANCE

DISLIKED FOODS

AVERAGE DAILY NUTRITION INTAKE (CALORIES, CARB/PROTEIN/FAT IF KNOWN)


TRAINING & ACTIVITY

AVERAGE DAILY ACTIVITY LEVEL

CURRENT WEIGHT TRAINING ROUTINE - IF APPLICABLE

CURRENT CARDIO ROUTINE - IF APPLICABLE

ARE YOU CURRENTLY WORKING WITH ANOTHER COACH?


GOALS

WHAT ARE YOUR MAIN HEALTH/FITNESS CONCERNS?

WHAT IS YOUR SHORT TERM HEALTH/FITNESS GOAL?

WHAT ARE YOUR LONG TERM HEALTH/FITNESS GOALS?

INTERESTED IN


OTHER

COMMENTS/CONCERNS/QUESTIONS

HOW DID YOU HEAR ABOUT MCGOWAN FITNESS?

PHOTO: FRONT (Please upload full-body front photo)

PHOTO: SIDE (Please upload full-body side photo)

Disclaimer

McGowan Fitness, LLC (Chris McGowan) or any associates giving advice are not doctors or registered dietitians. The contents of this program should not be taken as medical advice. It is not intended to diagnose, treat, cure, or prevent any health problem, nor is it intended to replace the advice of a physician. Always consult your physician or qualified health professional on any matters regarding your health. Terms of this program are subject to change.

I understand that I should consult my physician prior to starting an exercise and/or diet program. I hereby intend to be legally bound for myself, my heirs and executors, and waive and release any and all rights and claims for damages I might have against McGowan Fitness and/or Chris McGowan for any injuries and losses as a result of any diet, supplementation or training advice I may receive. I understand that the nutritional and training advice is only a recommendation and not intended to treat, cure or prevent any disease.

DIGITAL SIGNATURE (FULL NAME)

DATE

I have reviewed the above information for accuracy and give permission for this form to be collected by McGowan Fitness LLC

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