Intake Form Name * Name First First Last Last Where do you Live? * DOB * Gender * Male Female Other Gender Current Body Weight * Height (cm) * Short Term Goal * What is most pressing for you to achieve in the next 3 to 6 months. Why is this significance for you to attaining this goal. If there is an events for competition specify details, targets, goals and dates Long Term Goal * Why are you doing this all? What's the long game? What does the next 12 months to 5 years look like for you? Current Training (schedule & split) * Training schedule (days and times), and training split (what you do each day). Current Program Drop a file here or click to upload Choose File Maximum upload size: 26.21MB If you have difficulties uploading send to WhatsApp +61419717401 What have you found works for you? Or things you don't like or can't do. Any Limitations Any limitations for training. Things you can't do or don't like Equipment Access * Squat Rack Bench Press Incline Bench Chin Up Bar Leg Press Hack Squat Pendulum Squat 45 Hip Extension Dumbbells Kettlebells Sled Farmers Sandbags Yoke Trap Bar Safety Squat Bar Buffalo Bar Earthquake Bar Cable Machine Lat Pulldown Cable Row Leg Extension Seated Leg Curl Belt Squat Log Dip Station Hammer Machine Row Hammer Machine High Row Chest Press Machine Shoulder Press Machine Best Squat You put current but would also like your best and when you did this. Issues you have with squats? Technical difficulties, sticking points etc Recent Squat Video Drop a file here or click to upload Choose File Maximum upload size: 26.21MB Ideally your max effort or heaviest recently. If you have difficulties uploading send to WhatsApp +61419717401 Best Bench Press You put current but would also like your best and when you did this. Issues you have with Bench Press? Technical difficulties, sticking points etc Recent Bench Press Video Drop a file here or click to upload Choose File Maximum upload size: 26.21MB Ideally your max effort or heaviest recently. If you have difficulties uploading send to WhatsApp +61419717401 Best Deadlift You put current but would also like your best and when you did this. Issues you have with Deadlift? Technical difficulties, sticking points etc Recent Deadlift Video Drop a file here or click to upload Choose File Maximum upload size: 26.21MB Ideally your max effort or heaviest recently. If you have difficulties uploading send to WhatsApp +61419717401 Competition History What competition have you done, what did you achieve and when. Current Medical Conditions, Injuries, Training Pain Injuries you have or trying to return to training form. Any painn you get in training. Current Medical Conditions your are dealing with. Previous Injuries, Surgeries This can include what training pain you may have got in past that does affect you now but you feel it might. Please include all previous injuries or surgeries. What is your sleep like? * Answer the relevant questions in one paragraph; How many hours do you sleep? What quality is that Sleep? Do you have broken sleep? Do you have trouble sleeping? Do you have a varied schedule with your sleep? What issues have around sleeping? And any other information that is important to know about your sleep Other Physical Demands (occupation, hobby's & sport) Other activities you do outside of the gym and what are the demands. Medication or Substance Use This includes medicine, supplements, recreational, HRT or PED. Calories and Macros? Do you know your average calories & macro intake? Eating Habits What does a typical day of eating look like and does this differ day to day. Include snacks you might eat, how often you eat out etc Food Diary Drop a file here or click to upload Choose File Maximum upload size: 26.21MB If you have a food diary (tracking app) or plan you follow currently, supplement etc upload documents here. If you have difficulties uploading send to WhatsApp +61419717401 Drinking? Don't Drink Drink >3 monthly Drink Monthly Drink Weekly Drink Few time a week or daily I drink heavy often weekly to monthly If you are human, leave this field blank. Submit
