Gut Check Coaching
Motivation Is Fleeting. Discipline Is Key.
Complete the forms below so Coach Antonio can build your program around your goals, schedule, and health history. Start with the Consultation form — the Intake and PAR-Q+ come next.
1 · Consultation~2 min
2 · Client Intake~5 min
3 · PAR-Q+ Health~3 min
Personal Information
Preferred Coaching Format *
Select one… Online only In person — at my home In person — at my gym Flexible / either
Goals & Training
Primary Goal *
Select one… Lose weight / body fat Build muscle / get stronger Both — lose fat & build strength General fitness & energy Prehab / rehab & movement quality
Training Experience *
Select one… Beginner — never trained consistently Some experience — inconsistent Intermediate — 1–2 years consistent Advanced — 3+ years structured
Days available per week *
Select one… 2 3 4 5+
Equipment access
Full gym membership Home gym — some equipment Bodyweight / minimal only None yet
Describe your current exercise routine (if any)
In 90 days, what would success look like to you? *
Nutrition
Current nutrition approach
No structure at all Track loosely — don't know macros Understand macros — need accountability Solid nutrition — mainly need training help
Meals typically eaten out per week
0–2 3–5 6–10 Most meals
Dietary restrictions or foods you won't eat
Who handles cooking / groceries in your household?
Lifestyle
Occupation type
Desk job / sedentary On my feet most of the day Physically demanding job Variable / mixed
Average sleep per night
Less than 5 hours 5–6 hours 6–7 hours 7–8 hours 8+ hours
Stress level (typical week)
Low Moderate High Very high
Typical schedule
Consistent weekday schedule Shift work / rotating Frequent travel Unpredictable
Biggest obstacle to your goals *
Anything else Coach Antonio should know?
Confirmation
I confirm the information above is accurate to the best of my knowledge. I understand this intake form does not replace medical advice, and I will consult my physician before beginning a new exercise program if I have a medical condition.
Submit Intake Form
⚠️ You answered YES to one or more questions. That doesn't disqualify you — but please talk with your physician before becoming more physically active. Coach Antonio will discuss this with you and may request medical clearance before programming begins.
Personal Information
Health Screening Questions
The PAR-Q+ is the standard readiness screen used by certified fitness professionals. Answer every question honestly.
Medical History
Anything else about your health Coach Antonio should know?
Declaration & Signature
I have read, understood, and completed this questionnaire honestly. I confirm I am voluntarily participating in physical activity, and I understand that if I answered YES to any question above, I should consult my physician before becoming more physically active.
Based on the PAR-Q+ (Physical Activity Readiness Questionnaire for Everyone). This screening does not substitute for professional medical advice. Your responses are sent privately to Coach Antonio and are never shared.
Submit PAR-Q+ Form