Let’s make you strong.Fill out some info and we will be in touch shortly! We can't wait to hear from you! Name * First Name Last Name Email * Phone * (###) ### #### Occupation * Instagram Handle Which service(s) are you interested in? * High Contact Coaching Low Contact Coaching Programme Design Date of Birth * MM DD YYYY Bodyweight (KG) Height (CM) Sex * Male Female Other Prefer not to say Activity Level * Sedentary Lightly Active Moderately Active Very Active How Often Do You Drink/Smoke? * Have You Had Previous Injuries? If So, Please Explain Are You Dealing With Any Current Injuries? If So, Please Explain Best Squat (KG) * What is Your Squat Style? * High Bar Low Bar Don't Know How Often Do You Squat? * Best Bench Press (KG) * How Wide is Your Bench Grip? * Pinky Finger On/Inside Ring Middle Finger On Ring Index Finger On Ring How Often Do You Bench? * Best Deadlift (KG) * Which Deadlift Stance Do You Take? * Conventional Sumo Don't Know How Often Do You Deadlift? * Which Programs Have You Run in The Past, And How Did They Go? Link to Programs (if Relevant) http:// Exercises That Have Worked in The Past What Are Your Goals? * Have You Competed in Powerlifting? * Yes No Do You Want to Compete in The Future? * Yes No Coach Preference * Any Stephan Mahin Ibrahim Earlando Tom Ideal Start Date * MM DD YYYY How Did You Hear About Us? Physical Activity Readiness Questionnaire (PAR-Q) Moderate or vigorous exercise should not be a hazard for most people providing it is undertaken as part of a regular program starting from low intensity and progressing gradually. However, some people will need medical evaluation and advice before starting a program, some may need to exercise under medical supervision and some people may only be able to undertake restricted physical activity under medical supervision. ANSWER ALL QUESTIONS If you answer NO to all the questions, it is reasonable for you to assume that you are in a suitable physical condition to start a regular graduated exercise program. If you answer YES to one or more question you are first advised to consult your doctor prior to participating in any exercise program Has Your Doctor Ever Said You Have Heart Disease, High Blood Pressure or Any Other Cardiovascular Problem? * Yes No Is There a History of Heart Disease in Your Closest Family (Below Age 55)? * Yes No Do You Ever Have Pains in Your Heart and Chest, Especially Associated With Minimal Effort? * Yes No Do You Lose Your Balance Because of Dizziness or Do You Ever Lose Consciousness? * Yes No Do You Have a Bone or Joint Problem That Could Be Made Worse by a Change in Your Physical Activity? (Examples: Back, Hip or Knee) * Yes No Is Your Doctor Currently Prescribing Drugs for Your Blood Pressure or Heart Condition? * Yes No Are You Taking Drugs / Medication at the Moment or Recuperating From Recent Illness or Operation? * Yes No Are You Pregnant? * Yes No Are You Unaccustomed to Exercise and Aged Over 50, if a Woman or Over 40, if a Man? * Yes No Do You Know of Any Other Reason Why You Should Not Do Physical Activity? (e.g. Diabetes, Epilepsy) * Yes No If You Answered Yes to Any of the Above Questions Please Describe in More Detail as to Why You Answered “Yes” I have read, understood and completed the questionnaire Terms & Conditions Waiver: https://www.barbellcoalition.co.uk/waiver Privacy Policy: https://www.barbellcoalition.co.uk/privacy-policy I have read and agree to the terms above Thank you, we will be in touch soon!
