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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)

Sex
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):
-Front
-Side
-Rear end
(optional, only for personal use to check progress. Will never be made public WITHOUT the member's permission)
Mobility
Watch the video below and complete the mobility questions.
Ankle mobility (left)
How was the performance of the ankle mobility test (l)?
Ankle mobility (right)
How was the performance of the ankle mobility test (r)?
Hip mobility
How was the hip mobility test performed?
Shoulder mobility (left)
How was the performance of the shoulder mobility test (l)?
Shoulder mobility (right)
How was the performance of the shoulder mobility test (r)?
Muscle size
-Stand up straight
-Apply a measuring tape around your muscles or waist
-Do not pull the measuring tape too tight
-If you don't trust it, you can do it 2 to 3 times and then take an average.

You can purchase a measuring tape at a department store near you! If this does not work now, we will measure this at a later time. We discuss this during the intake.
Right leg
Resourse
Right arm
Lifestyle
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 OBJECTIVE(S)
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)
Needs

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?

Op welke datum wil je het liefst van start met het programma? (Zodat jij gaat groeien!)

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?
Health
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? ?
Important
Instagram
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 

“Involved and motivating”

Jordi is a committed personal trainer. He keeps a close eye on progress and provides motivation where necessary. Jordi knows a wide range of exercises and training, so that the training remains varied and intensive. He also knows a lot about the combination of sports and nutrition. ★★★★★
Mark van Vliet

Mark van Vliet, 27

“More confidence and a clear routine”

Jordi De Haan Personal Training has given me the confidence to go to the gym and build up a regular exercise routine twice a week. ★★★★★ Read more.
Maarten Visser

Maarten Visser, 26

helped people

Clients helped

training program

Created training programs

Personal training

Hours of personal training delivered

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Let's meet!
Plan your free introduction now.

Together working on building muscle mass.
Together working on creating a flexible nutritional pattern. 

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Vrijblijvend en 100 procent gratis

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