Remote Coaching Assessment Questionnaire

Personal Details

First name

Last name

Birthday

Month

Day

Year

Email

Phone / WhatsApp

We use WhatsApp as part of our feedback process. Please include your country code so it's easy for us to stay connected

Address

Occupation/Position

Do you currently travel regularly for work or leisure?

Yes

No

If Yes: “Please briefly describe your travel schedule or frequency”

Health & Medical

Do you have any current or past injuries that may impact your training

Yes

No

If Yes: “Please specify the nature and timeline of the injury/injuries”

Do you have any diagnosed medical conditions (e.g. high blood pressure, diabetes, asthma)?

Yes

No

If Yes: “Please describe”

Are you currently taking any medication?

Yes

No

If Yes: “Please list the medication(s) and reason for use”

Have you received medical clearance to participate in physical training?

Yes

No

Lifestyle & Movement

What is your current weekly training load?

e.g. “3 gym sessions + 1 trail run + 1 yoga"

What are your average stress and energy levels like throughout the week?

How many hours do you typically sleep per night?

Do you work at a desk or sit for extended periods?

Yes

No

Goals & Preferences

What are your main goals for this mentorship?

What would success look like to you at the end of 12 weeks?

Do you have any preferences for session format or coaching style?

Consent & Final Notes

I understand that the information I’ve provided will be used to design a personalised movement program.

I confirm that all the information provided is accurate to the best of my knowledge

Is there anything else you’d like to share?

When would you like to get started?