Assessment Form 1-ON-1 COACHING Please fill in the form below so I can get a better understanding of what goals you hope to achieve from your 1-on-1 coaching DOB Exercise Hours Per Week Height (cm) Weight (kg) Smoker? Smoker? Yes No Drinker? Drinker? Yes No Medications (prescribed)? Medications (prescribed)? Yes No Allergies/Intolerances? Allergies/Intolerances? Yes No Any past/present injuries? Any past/present injuries? Yes No Vegan/Vegetarian? Vegan/Vegetarian? Vegan Vegetarian Food Likes? Food Dislikes? Exercise Likes? Exercise Dislikes? What are your goals? First Name Last Name Email Phone Number Next Step Have you completed this form already? Click here to go to the next step.