Online Trainer Coaching (OTC) Intake Form

Welcome to Online Trainer Coaching!

The form below will help us modify your program appropriately and help your coach get to know you and where you are coming into OTC. It will take 15 minutes to fill out. Please complete it ASAP (by this Friday at the very latest).

If you are not 100% sure about any question on this form, please fill it out to the best of your abilities and then email [email protected] afterwards to discuss. Please DO NOT submit this form twice. We can always adjust later on.

Please note that form progress is not saved. The form must be completed in full in one go.

We can’t wait to work with you!

-The Online Trainer Coaching Team

OTC Intake
Must match the email used when you registered for OTC.
Gender *
Primary Fitness Goal *
Your program will be designed to maximize your chosen goal. If Hypertrophy is your primary goal, you must train in a gym. If fat loss is your primary goal, you have the option to train in-home or in a gym. If training in-home, the following equipment is required: Resistance bands/tubing, mini-bands, sliders (paper plates will suffice), a jump rope and a suspension trainer (i.e. TRX)
Current Fitness Level *
How many days per week are you able to workout? (minimum) *
Includes all aerobic, anaerobic, and weight training
Please be as detailed as possible. Also, if necessary, your coach will reach out via email for more information.
On a scale from 1-10, how would you rate your current sleep routine? (1 = poor, 5= decent, 10 = excellent) *
On a scale from 1-10, how you would rate your stress levels? (1 = very high, 5= moderate, 10 = very low) *
On a scale from 1-10, how committed are you to achieving your health and fitness goals? *
1 = I just wanna sit on my couch and eat potato chips, 10 = I'll do whatever it takes even if it means broccoli and chicken all day, evvvvvery day!
Please check all of the equipment items that you DO HAVE access to *
This section is very important. Check off all of the equipment that you DO have access to. Our programs use a wide variety of workout equipment. It is possible to modify after you get your program based on equipment availability but this could cause a delay in your workouts. Please do as good of a job as you can checking off all equipment that you DO have access to. We will assume that anything CHECKED is fair game to include in your program.

Physical Activity Readiness Questionnaire (PARQ)

IMPORTANT: The final seven questions of your intake serve as your Physical Activity Readiness Questionnaire (PARQ). If you answer "Yes" to one or more of the following questions, consult your physician before engaging in physical activity. Tell your physician which questions you answered "Yes" to. After a medical evaluation, seek advice from your physician on what type of activity is suitable for your current condition.
Has your doctor ever said that you have a heart condition and that you should only perform physical activity recommended by a doctor? *
Do you feel pain in your chest when you perform physical activity? *
In the past month, have you had chest pain when you were not performing any physical activity? *
Do You Lose Your Balance Because Of Dizziness Or Do You Ever Lose Consciousness? *
Do you have a bone or joint problem that could be made worse by a change in your physical activity? *
Is your doctor currently prescribing any medication for your blood pressure or for a heart condition? *
Read and agree to the liability and informed policies document linked below. *
Click the link below to read the liability and informed policies document: https://docs.google.com/document/d/1eSqEhtR8rRovQq7YWTj7fHbsOInAhtvTJtM2XXkipVQ/edit?usp=sharing
By entering your initials in the box below you are effectively providing your signature, indicating that you agree to all the information on this form, and the information you have entered is true and accurate to the best of your knowledge.

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