Strength & Conditioning Intake

Client Information

First Name *

Last Name *

Email *

City

Country

Age *

Gender *

Height *

Weight *

Body Fat % (BFP) *

Method to Estimate BFP *

How long have you trained & How consistently? *

Pictures & Attachments

Front Picture

Side Picture

Data Attachment

Maximum Strength Data

Push-ups for 1 minute *

Pull-ups for 1 minute *

Bench (lbs) (Weight & Rep Max) *

Squat (lbs) (Weight & Rep Max) *

Deadlift (lbs) (Weight & Rep Max) *

Additional Data for Athletes, Law Enforcement & Military

Vertical Leap (in.) (Two Feet & No Steps)

Power Clean (lbs)

Sprint (seconds) (Include Distance)

NFL Combine Cone Drill (seconds)

225 lb Bench Press Rep Max

Exercise & Diet Information

What are your goals? *
Considerations: Are you working out for the first time? Are you trying to get back in shape? Are you wanting to gain lean muscle? Are you wanting to focus on certain muscle groups? Are you training for something specific?

How often are you prepared to train in one week? *
How much time per session are you willing to give? *

Which applies to you:
A) Train near maximal effort each training day
B) Minimal Effort / Maximum Results
C) I will train as hard as I need in order to reach my goals

Are you on a special diet? *
For example, Vegetarian, Vegan, Paleo, Atkins, Keto, etc.

Do you know your Metabolic Rate (AKA, daily caloric needs)? *
If not, at the very least we recommend purchasing our monthly dietary analysis plan. The driver of physique and performance goals is diet. More importantly, a diet made to your bodys needs via your bodys data which will set the stage for success.

Do you have any current or past injuries? *
The type and severity of an injury can impact the design of your program.

What is your currect execise regimen and do you perform physical activities outside of this routine? *
For example: Do you do additional cardio? Do have other hobbies?

What is your occupation and activity level?
For example: Sedentary, Moderate, Active, Very Active
Please explain further below.

Do you have access to a fully equipped gym? *
If No, do you want an in-home routine?
If you do want an in-home routine, what equipment do you own? (For example: dumbbells, kettlebells, bands, etc.)

What supplements are you taking?
Would you like supplement recommendations?

Other Information?
For example: health conditions or considerations, heart issues, diabetic, other relevant information, etc.

Average hours of sleep per night

Wrist circumference at smallest point

Ankle circumference at smallest point