Personal Training intake form

Are you ready to build muscle mass with a flexible diet? Please complete the questions below as honestly as possible, so that I get a good idea of who you are and what your goals are.

Everything clear!

I also gain sufficient insight into any limitations you may have during training. This means I can make the most important adjustments for you in advance personal program. 

(Completion time: 10 minutes)

Personal data
Address data
Physical composition
Tips for measuring scale:
Stand up straight, try to stand still and put your feet together
Photo current physical (you do not see the photos, but they are uploaded):
-Rear end
(optional, only for personal use to check progress. Will never be made public WITHOUT the member's permission)
Physical activities while doing your daily activities?
Do you smoke?
Do you drink alcohol?
Mental and physical fitness
How much stress do you experience in daily life?
How easily do you gain weight?
How well can you eat by feeling? To clarify: Do you know how many calories you consume every day without registering?
Sporty background
What is your level with regard to fitness/strength training?

Sporting objective

What is your objective for the coming period?

SMART stands for: Specific, Measurable, Acceptable, Realistic and Time-bound Example: "I want to build eight kilograms of muscle mass within today and January 1, 2024 with an average of three gym sessions per week."
What are the chances that you will achieve your goals?
What are the chances that you will continue to build muscle mass forever (consistency)

How often would you like to train per week?
Which day(s) would you like to train?
Which part of the day would you like to train?

Power supply

How many meals do you eat on average per day?

Flexible nutritional plan

A flexible diet is defined by me as: '''A diet with personal calorie needs and macro nutrients (proteins, fats and carbohydrates) where the calories vary and are easy to adjust. Freedom in food choices and learning to eat based on feeling is the basis for this.'' ?
Do you pay attention to the number of kilocalories per product?
Have you ever become dizzy or fainted during exercise?
Have you ever had an epileptic seizure in the past?
Has a doctor ever advised you not to exert maximum physical effort? ?
Anything else to report?
On this intake the Terms and Conditions and the privacy policy from Jordi de Haan Personal Training applies.

✉ You will receive a message within 24 hours to create a digital intake