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Online Training Application
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Name
(Required)
First
Last
Phone
(Required)
Email
(Required)
Address
(Required)
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Birthday
(Required)
MM slash DD slash YYYY
Tell us about yourself!
Self Description
Describe yourself to us:
Support System
Describe your support system, i.e., friends, family, work environment, etc.
Profession & Schedule
What is your profession and what is your work schedule like?
Work Life
Do you work 12-hour shifts?
Yes
No
Snacks & Meals
Is hard to get a snack in during the day?
Yes
No
Travel
How often do you travel?
Never
1-2x per year
3-5x per year
Once a month
More than once a month
Sleep
How many hours of sleep would you say you get each night on average?
Physical Information
This is your comprehensive client information assessment, in which we will ask you to provide some relevant personal information. The answers to these questions are essential in order to allow us to design an optimized individual fitness program for you. Please answer all questions in the most accurate manner possible. Please recognize that it is your responsibility to work directly with your physician before, during, and after seeking fitness coaching from TwinFitness. As such, any information provided is not to be followed without the prior approval of your physician. If you choose to use this information without the prior consent of your physician, you are agreeing to accept full responsibility for your decision.
What is your body weight now?
In kilograms
What was your body weight a year ago?
In kilograms
Weight Distribution
If you had to chose…
Insulin Resistant (you hold weight in your midsection)
Estrogen Dominant (you hold weight in your thighs and back of arms)
Both
Struggles
Cardio
Strength Training
Nutrition
What do you feel you struggle with the most?
Do you have injuries (bone or muscle) that may interfere with exercising?
Present/Past Health History
High Blood Pressure
Low Blood Pressure
Seizures
Diabetes
Fainting or Dizziness with or without physical exertion
High Cholesterol
Are you currently taking:
Birth Control
Hormone Replacement Medication
Hormone Replacement Medication
Anti-anxiety Medication
Do you smoke or use tobacco products?
Yes
No
Nutrition
Current Diet
What is your current diet like right now?
Supplements
Are you currently taking supplements?
Yes
No
If you are currently taking supplements, please list them below:
Previous Diet
What didn’t you like about your previous diet?
What is your favorite healthy food?
Food Allergies/Aversions
Do you have any allergies or aversions to certain foods?
Exercise
Peak Energy
Are you a…
Morning Person
Night Owl
No Preference
Daily Exercise
How much time per day can you devote to exercise?
20 Minutes
30 Minutes
45 Minutes
60 Minutes
90 Minutes
90 + Minutes
Current Workout Regimen
Describe your current workout plan:
Cardio/Weight Training Frequency
How many days per week do you devote time to do cardio or weight training?
High-Impact Excercises
Can you perform high-impact exercises? Ex: jump or run
Yes
No
Gym?
Do you have access to a gym?
No, I need in-home workouts
Yes, I have access to a gym
Goals
Your goals are our goals–let’s help you reach them!
What are your goals for this year?
Additional information
Is there any additional information that would help us better serve you?