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Client Results
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Online Client Intake Form
Thank you for your interest in working with us.
Please fill in the form below.
Fill in this form
Online Client Intake Form
Name
*
First Name
Last Name
Email Address
*
Country of residence
Program choice
*
Consultation - training program
Consultation - nutrition program
Consultation - training and nutrition program
Coaching - training program (1:1 coaching)
Coaching - nutrition program (1:1 coaching)
Coaching - training and nutrition program (1:1 coaching)
Only for coaching programs - choose duration
1-2 months
3 months or longer at discounted rate
Gender
*
Male
Female
Body weight
*
Please add the unit you use (kg or lb)
Body fat percentage
Feel free make an estimate, if you have never measured it
Height
*
Please add the unit (cm or feet and inch)
Age
*
Occupation
*
sedentary without daily movement (e.g. office job, going to work by car)
sedentary with daily movement (e.g. office job, cycling or walking to work)
occupation with prolonged standing (e.g. lab work)
occupation with strenuous work (e.g. nurse)
How many times a week do you train?
*
Years of strength training experience
What time of the day do you train?
How long are your training sessions?
*
(in minutes)
What type of training do you do?
*
Strength Training
Endurance Training
Both
For strength training, what type of lifting do you do?
*
light to moderate lifting with high or low intensity (e.g. powerlifting training with low rep number and long rest periods of 3-5 min)
moderate to vigorous lifting (e.g. combination of powerlifter and bodybuilder type of training)
vigorous lifting ('Bro-bodybuilder pumps style' of lifting)
If you do endurance training or any other training, please, describe what exaclty you do.
What is your body composition and strength goals?
*
Fat loss
Muscle/Strength gain
Both at the same time
How many meals do you eat in a day?
In case you train in the morning, do you have breakfast before or do you train fasted?
Do you track your calorie and macronutrient intake? If so, how many kcal, grams carbohydrates, grams protein and grams fat do you eat a day?
*
Please describe what you usually eat during a day (e.g. breakfast: 2 pieces of bread with 2 tbsp peanut butter and coffee, lunch:...)
How often do you eat out? When you eat out, what food do you usually go for?
You are
*
Vegan
Vegetarian
Mostly plant-based
None of the mentioned above
Do you have any food intolerances or foods you don't like?
*
Do you have any medical conditions I should be aware of?
*
How many days a week are you willing to train?
Do you have access to a gym?
*
Do you take any supplements? If so, please list the supplements you take below.
How much time do you have for food prep?
*
What is the biggest challenge for you to reach your goal?
*
Tick the box to accept the conditions
*
Legal disclaimer: The content of this program is not intended to be a substitute for professional medical advice. Always seek the advice of your physician or another qualified health provider for any questions you may have regarding a medical condition, changes to your diet or exercise regime. The information provided in this program is based on Anastasia Zinchenko's and Maayan Eliasi's experience, analysis and interpretation of scientific research. Anastasia Zinchenko and Maayan Eliasi do not take any responsibility for how you choose to use the information provided. The information provided is to assist you in making an informed decision and should not be seen as a prescribed diet or exercise plan. By accepting these conditions you forego all rights to hold Anastasia Zinchenko or Maayan Eliasi liable for any damages caused in relation to following their advices as your coaches. There is no possibility to freeze or cancel the plan after its beginning.
I accept
Thank you!