Athlete Information

Please take some time to fill out the following form. It may seem a bit lengthy, but it is important that I get as much information from you as possible now, so we can spend our first video consultation setting up your plan. Many of the nutrition questions are optional, should you not feel comfortable responding to some of them. Please remember, however, that the more information I have the better I can help you progress on your fitness plans and meeting your goals, so please set aside 30 minutes or so to answer these questions as thoroughly as possible. Afterward, you will be able to pay and schedule our first video consultation.

If you have any questions or concerns about the application or working with me in general, please feel free to contact me through email (natveiga@udel.edu) or DM me on Instagram (@swolboy.fit).

Email

First Name

Last Name

Pronouns

Age

Height

Birthday

Time-Zone

Skype/Google Meet

Mailing Address

City

State

Country

Zip

Are you currently working with another coach/trainer?

Are you working with a nutritionist, registered dietitian, or other nutrition consultant?


Exercise History and Attitude

Please fill out these questions about your current and past exercise history and experiences with/feelings toward exercise in general. If you have any questions or concerns about the application or working with me in general, please feel free to contact me through email (natveiga@udel.edu) or DM me on Instagram (@swolboy.fit).

Are you interested in any weight/physique changes as part of your goals?


If yes, what is your current weight? Please give a brief description of your weight history.

What is your daily, non-exercise activity level (housework, walking to work or school, home repairs, moving around at work, gardening)?

Do you have any negative feelings toward, or have you had any bad experience with, physical activity programs?

If yes, please specify.

Have you tried anything in the past to change your habits, health, fitness, and/or body?

Which of those things worked well for you?
Which of those things didnt work well for you?

How much time are you willing to devote to an exercise program? Please answer in minutes/day, and days/week.

What are your short-term goals (in the next 8 to 12 weeks)?

What are your long-term goals?

Right now, how much do people around you and your environment support your health, fitness, nutrition, and/or behavior change goals?


Weight Training

Answer these questions about your current weight/resistance/bodyweight training (if you perform any) as best you can, so I can have an idea of where you're at.

Please summarize your current resistance/weight training split/regimen (if any)

How many sets do you generally perform per workout? If unknown, would you descruve your training as low, medium, or high volume(few, average, or many sets/reps per workout)? What rep range(s) do you work in? How often do you train to failure or past failure?

Rate your perception of the exertion of your current weight training program:


Cardiovascular Training

Answer these questions about your current cardio/endurance/aerobic training (if you perform any) as best you can, do I can have an idea of where you're at. If you don't do any cardio, write "none".

Please summarize your current cardiovascular training regimen (if any). Include schedule, intensity and type.

Rate your perception of the exertion of your current cardio program


Nutrition

Please answer as many of these questions as you feel comfortable as best you can, so I can have an idea of where you're at.


I'm not a nutritionist or registered dietician so I do not develop personalized meal plans, however I am certified to help with general nutrition education, teach you dietary habit change, and provide you with the tools, resources, and recommendations to guide you toward a diet that meets your goals. Answering these questions as thoroughly as you can will help me understand how your nutritional habits will affect your training in the gym, and help as a baseline for future nutritional education as it pertains to your personal health and fitness goals.
If you are not seeking weight change of nutritional guidance, please feel free to write n/a on every question and go on to the next section.

As best as you can remember right now, tell me generally about an average day of eating and drinking. Include time of day and what you might normally eat/drink around that time. This doesn’t have to be perfect; just capture your usual patterns. If you know them, please include total daily calories, carbs, protein and fats.

Do you have any food allergies or intolerances? Any additional information relevant to your nutritional status?

List all dietary supplements you use, including their frequency and dose

Right now, on a scale of 1-10, how consistent would you say you are with eating habits?

If you're less consistent than you'd like to be, what seems to get in the way or knock you off track?

What has your relationship with food been like in the recent or further past? Is it something you are concerned about?

Do you have regular/nearby access to a grocery store/local food or farmer's market/food pantry? Do you have any concerns about accessing or purchasing food?


Stress & Recovery

Think about all the activities you’re involved in (e.g., work, school, caregiving, housework, travel). Then assess as best you can:

Given all the demands of your life, what is your typical stress level on an average day?

On average, how many hours per night do you sleep?

How do you normaly cope with stress?


Medical History

Put "N/A" for fields that cannot be answered. Fields in this section cannot be left blank.

Please list any current medical diagnoses (e.g. Kidney disease, type II Diabetes, hypertension, PKU, etc.) – If none, type “none”. If present, are the conditions stable as determined by a qualified health care professional?

Do you have any chronic illness or disability that you feel would impact your movement or exercise experience? In what way?

Family history of medical diagnoses (Who? What? Example: Mother- Type II Diabetes). If none, type "none".

List all medications you CURRENTLY take (insulin, birth control, etc.), including their frequency and dose

Medication History (Past Medication)

Menopause status (if applicable):

Other


Lifestyle & Readiness

Your personal life, mood, self image, sense of self, life stressors, etc. can effect your adherence to a fitness program or how you experience the program.

Can you describe a typical or recent day in your life that would help me understand you?

How READY are you to implement the changes in training, nutrtiion, and behavior from our programming?(1 Not at all - 10 Completly)

How WILLING are you to implement the changes in training, nutrtiion, and behavior from our programming?

Please list three prominent stressors you have at this time that may affect your ability to adhere to a fitness program.

Has your weight or shape influenced how you think about (judge) yourself as a person?

Do you have any food or exercise rituals that concern you?


If yes, please explain

What do you currently track or have tracked in the past?

If other, please explain

What would you be comfortable or willing to track?

What do you expect from me as your coach?


Waiver

We state: NATALIE VEIGA (referred to in the rest of this waiver as “Nat Veiga”) is not a licensed dietitian, nutritional specialist, or physical therapist. All information you obtain will be directly from Nat Veiga’s own experiences, certifications, and continuing education as a trainer/coach. It is of best interest for anyone looking to start a workout/exercise/strength/general fitness and/or diet/nutritional program to consult a physician before doing so; it would be wise to have blood work done (specifically for diet/nutrition changes), and a physical performed by a licensed physician for either changes in exercise OR diet.

Before submitting this application, please read and understand the following: You(customer) totally understand that you(customer) may injure yourself as a result of participation in a workout/exercise/strength/general fitness program, and hereby release Swol Boy Fitness and Nat Veiga from any liability now or in the future for any injury, including, but not limited to heart attacks, death, muscle strains, pulls or tears, broken bones, shin splints, heat prostration, knee/lower back/foot injuries and any other illness, soreness or injury however caused, occurring during or after your participation in the workout/exercise/strength/general fitness/nutrition program offered.

By submitting this application, you state that in consideration of your participation in Swol Boy Fitness's (Nat Veiga’s) workout/exercise/strength/general fitness/nutrition program, you for yourself, your personal representatives, administrators, heirs and assigns, hereby holds harmless Nat Veiga and Swol Boy Fitness from any claims arising from your participation in the workout/exercise/strength/general fitness program.

By submitting this application, you agree that you have listed all current/past medications and diagnoses, and that you have spoken with your doctor and been cleared to participate in your planned activities.

By submitting this application, you agree that you are being seen by a physician for your current medical diagnoses/medication regiment, and if for any reason you stop seeing your current physician for the above conditions/medications you will inform Swol Boy Fitness (Nat Veiga).

By submitting this application, you affirm that you have read and also fully understand the above information, and that you have been completely honest with Nat Veiga and Swol Boy Fitness in regards to the questions asked in this application form. You have been given the opportunity to present questions in all related matters. You agree that if at anytime the status of your condition changes you will inform Swol Boy Fitness (Nat Veiga).

Do you agree with the terms of this waiver?