LET’S WORK TOGETHER.If you are interested in working together, please fill out this form. Khelvin will be in touch shortly with next steps. Thank you. Name * First Name Last Name Email * Message Age * Height * Weight * Health & Medical History * 1. Do you have any chronic health conditions (e.g., diabetes, heart disease, asthma)? Yes No 2. Are you currently taking any medications? Yes No 3. Do you have any injuries or physical limitations? Yes No 4. Have you had any surgeries in the past 5 years? Yes No Lifestyle & Habits * 5. How would you rate your overall stress level? low medium high 6. How many hours of sleep do you get per night on average? < 5 5-7 > 7 7. Do you smoke? yes no 8. How often do you consume alcohol? never occasionally regularly 9. Do you follow any specific diet or eating plan (e.g., vegetarian, keto, intermittent fasting)? yes no 10. How many servings of fruits and vegetables do you typically consume per day? 1-2 3-4 5+ 11. Do you have any food allergies or intolerances? yes no Fitness & Activity * 12. What is your current level of physical activity? Sedentary (little or no exercise) Lightly Active (light exercise or sports 1-3 days/week) Moderately Active (moderate exercise or sports 3-5 days/week) Very Active (hard exercise or sports 6-7 days a week) 13. What types of exercise do you currently engage in? Cardio (running, cycling, etc.) Strength training (weight lifting, resistance exercises) Yoga or Pilates Flexibility or Mobility exercises Sports or recreational activities Other 14. How many days per week do you engage in physical activity? 1-2 3-4 5+ 15. What is your primary fitness goal? lose weight build muscle improve endurance improve flexibility & mobility general health & wellness other 16. What is your biggest challenge when it comes to fitness? motivation time consistency lack of knowledge other Wellness & Mental Health * 17. How do you typically manage stress? exercise mediation or mindfulness hobbies or social activities rest or sleep other 18. How often to you practice self-care or relaxation techniques (e.g., taking time for yourself, relaxing activities)? never occasionally frequently 19. Do you feel like you have a work-life-routine? yes no Goals & Motivation * 20. What motivates you to improve your fitness and wellness? personal health aesthetic goals (e.g., appearance, body composition) physical performance (e.g., strength, endurance) mental well-being other 21. What are your short-term fitness goals (next 3-6 months)? Describe here... 22. What are your long-term fitness goals (1 year +)? Describe here... 23. How committed are you to achieving your fitness goals on a scale from 1-10? 1 being not committed and 10 being highly committed. 1 2 3 4 5 6 7 8 9 10 Thank you!
