COACH PLUS PLAN * First Name Last Name GENDER FEMALE MALE OTHER Date of birth * MM DD YYYY HEIGHT * weight * Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Email * Occupation: (This information helps gauge your activity level outside of planned exercise, including unpaid work and study.) EMERGENCY CONTACT NAME * RELATIONSHIP * PHONE * GENERAL PRACTITIONER'S NAME * GENERAL PRACTITIONER'S PHONE * GENERAL PRACTITIONER'S CLINIC NAME * GENERAL PRACTITIONER'S CLINIC ADDRESS * DLVR Plans: Which plan best suits your goals? * Meta-Coach Plan: Prime and support the body for fat loss Build-Coach Plan: Build Muscle and strength Form-Coach Plan: Optimise lifestyle performance IF YOUR GOAL IS FAT LOSS, HOW MUCH WOULD YOU LIKE TO LOSE? Would you like to include any of the following methods to help track your progress? (Please select all that apply) * This is optional, but it can offer valuable insights into your journey. Circumference Measurements Progress Pictures Bodyweight Calories (myfitnesspal) Steps None Each coaching plan includes one Personal Training session. Additional sessions may be available upon request for $60 per session. Every effort will be made to accommodate your preferences, based on availability. * Main Session Preference Please enter your preferred day and time for your included session: * Additional Session Availability (Optional) If you're interested in booking extra sessions, please list any other days/times that would work for you: What days would you prefer to train on your own? * Where would you prefer to train when you're not training with a personal trainer? * Gym Home I only want to train when I'm with a personal trainer. Please list at-home equipment * At-home equipment is not essential but can be incorporated into your training if available Have you followed any fitness plans before? * YES NO If yes, please list below: Have you followed any diets before? * YES NO If yes, please list below: Please note any suggestions or personal considerations you may have in working with DLVR. Thank you! DLVR will be in touch as soon as possible.
