PERSONAL INFORMATION
Name Last Name Email
% of Body Fat Gender Instagram
One-on-One Coaching Program--- Nutrition + Cardio Nutrition + Training + Cardio Do you agree with your progress being published on my social media? (Please indicate if you prefer anonymously)
TRAINING
1. Do you train at home or at the gym?--- Home Gym 2. How many days a week do you exercise?
3. What is the duration of each session? 4. What kind of training do you follow?--- Bodybuilding Powerlifting Weightlifting Crossfit None Other
5. How would you describe your relationship with working out?
CARDIOVASCULAR
1. How many times a week do you do cardio? 2. What is the duration of each session?
3. What kind of cardio do you do?--- HIIT LISS MISS Plyometrics None Other
OTHER
2. Do you consider that the hours you rest are of quality? If you say no, explain why.
Yes No ¿Por qué?
MEDICAL INFORMATION
1. Have you had a blood test in the last year?
Yes No Please put any findings related to the test.
2. Do you take any prescription medication permanently or semi-permanently?
Yes No If yes, list the medications:
3. Do you have diabetes I or II?Yes No 4. Do you have high blood pressure (hypertension)?Yes No
5. Do you have high cholesterol?Yes No
6. Do you smoke?Yes No If yes, how many per day?
7. Do you consume alcohol?Yes No If yes, how many times per week?
8. Do you have any medical conditions or problems that cause pain not mentioned above?Yes No If yes, please explain:
ONLY WOMEN
1. Do you have a regular menstrual cycle?Yes No 2. What type of birth control do you use?
3. Have you ever seen an OB/GYN regarding hormone/menstrual irregularity?Yes No f yes, please specify:
GOALS
1. If you had to list them, what would you say your top five priorities in your life currently are?
Priority 1 Priority 2
Priority 3 Priority 4
Priority 5
2. Personal goals (Physical). Provide 3-5 goals related to your body. Be as specific as possible.
Goal 1 Goal 2
Goal 3 Goal 4
Goal 5
3. Personal goals (Non physical). Provide 3 goals unrelated to your body. Be as specific as possible.
Goal 1 Goal 2
Goal 3
4. Why did you decide to be part of the KV Fitness Team?
DESCRIBE YOUR DIET
1. Do you follow a flexible approach?Yes No If yes, please indicate your current calories and macronutrients.
2. Describe your diet: (For example, how many meals do you eat, what do you eat in each of them, etc.)
3. How long have you been following your current eating plan? 4. Are you losing, maintaining or gaining weight with it?Losing Maintaining Gaining
5. How many free meals/cheat meals do you have per week?1 2 3 4 5 More than 5
6. Provides a detailed list of any existing and/or pre-existing food allergies, food intolerances, nutrient deficiencies, illnesses, etc. For example, lactose intolerance, peanut allergy, anemia, celiac disease, etc.
7. Have you ever done online coaching?Yes No If yes, tell me about your experience.
8. Do you think someone has influenced your current physical state?Yes No Who
9. Have you ever suffered from an eating disorder like anorexia nervosa, bulimia nervosa, or binge eating disorder?Yes No If yes, tell me about your experience.
10. Please include your progress photos.
Protocol: Three photos (front, side, and back) in the morning preferably before eating and after using the bathroom.
Front Side Back
