Your contact details Name*
First
Last
Email*
Please enter the email address you'd like to use for correspondence for this programme.
Messaging* Messaging is an important part of the coaching process. Please provide your mobile number for messaging via whatsapp.
Address*
Your goals. Everyone has their own reasons for working on their health and fitness. Please share what you hope to get out of this coaching experience by rating the importance of the following:
Lose weight? 1 = lowest priority, 10 = highest priority.
Add muscle? 1 = lowest priority, 10 = highest priority.
Look and feel better? 1 = lowest priority, 10 = highest priority.
Learn how to stay consistent? 1 = lowest priority, 10 = highest priority.
Gain more energy and vitality? 1 = lowest priority, 10 = highest priority.
Get off medications? 1 = lowest priority, 10 = highest priority.
**Please note, advice on whether or not you need to take medication will be a discussion held between you and your doctor only. The purpose of this question is to assess if getting off medication, if you are on any, is a priority for you.
Gain skills in how to manage your eating? 1 = lowest priority, 10 = highest priority.
Learn how to maintain your weight, performance, and/or habits after achieving your goal? 1 = lowest priority, 10 = highest priority.
Get stronger? 1 = lowest priority, 10 = highest priority.
Improve your sport performance? 1 = lowest priority, 10 = highest priority.
If you had to choose between the following 4 goals, which one is most important to you? Your current weight is roughly? Record a rough estimate of your weight in kilograms (kg)
Your current exercise and nutrition habits. If you had to select only one physical goal, which would you choose? Please choose the statement that best matches your current exercise routine and needs.
Do you currently have an injury, a movement limitation, or pain that limits your ability to exercise? Please advise if you have a current injury or any pain that impacts movement for you.
Please briefly describe your injury(s).
Because of my injury, I think I’d benefit from having a programme including:
What are your biggest nutritional challenges? Check all that apply.
How many of your meals are prepared at home each day? Please select…
Please share your general food preferences. You can refine your choices and add more detail later. Which high protein foods do you like? Here are some foods that are high in protein. Please check off all that you like and WILL
Which common vegetables do you like? Here are some foods that are high in protein. Please check off all that you like and WILL eat. Here are some common vegetables. Please check off all that you like and WILL
Which foods that are higher in carbohydrates (sugars and starches) do you like? Here are some foods that are higher in carbohydrates (sugars and starches). Please check off all that you like and WILL
Which foods that have healthy fats do you like? Here are some foods that have healthy fats. Please check off all that you like and WILL
Do you have any food allergies? A food allergy is when the body's immune system reacts unusually to specific foods. If you are sensitive to any food, please check 'No' and see the question below.
Which foods are you allergic to? Check all that apply.
If other, please clarify.
Are there any foods that you're sensitive to (e.g., they cause excessive gas, bloating, other GI upset, stuffiness, headaches, rashes, acne, etc.)? If you are sensitive to any foods, please check 'yes' in the following food intolerance question.
Which foods are you intolerant to? Check all that apply.
*Please note;
Lactose intolerance is when you can't digest lactose, the sugar found in dairy products. You'll often get symptoms like stomach pain, gas, and diarrhea. With a milk allergy, the symptoms affect more than just your digestive tract. A milk allergy is when your immune system thinks dairy is a foreign invader and attacks it by releasing chemicals called histamines. Symptoms can range from wheezing problems to vomiting and diarrhea.
If other, please clarify.
Do you have any other dietary preferences or restrictions? Such as eating a vegetarian or kosher diet, abstaining from grains etc...
Please select dietary restrictions. Check all that apply.
If other, please clarify.
Are you using any nutritional supplements? Check all that apply.
Which supplements do you regularly take? Check all that apply.
If other, please clarify.
On an average day, how many glasses of water do you drink? Please select...
On an average day, how many of your meals include at least a palm-sized portion of protein (like meat, fish, dairy, eggs, or other protein dense plant foods)? Please select...
On an average day, how many of your meals include at least one serving of fruit or vegetables? Please select...
On a scale of 1-10, how knowledgeable are you now about making smart food choices? (1 = I know very little; 5 - I have some knowledge; 10 = I'm a nutrition expert)
How many hours a week do you do some form of aerobic or cardio-type training? (E.g. jogging, brisk walking, cycling, boxing, fast swimming, etc.) Please select…
How many hours a week do you do some form resistance training? (e.g. lifting weights, bodyweight resistance classes (such as frame), resistance weight training classes (such as a body pump class).
How many hours a week do you do some form of intense conditioning or anaerobic interval-type work? (e.g. sprinting, Crossfit, MMA, intense circuit-based classes, etc.)
How many hours a week do you do some form of low-intensity movement? (e.g. gentle walking, yoga, golf, etc.) Please select...
Your general health details. A lot of factors can affect health and fitness such as your metabolism and gender/sex. This section helps understand how to create the most personalised program for you.
When were you born? As best you can describe, what's your ethnic heritage? Check all that apply.
If other, please clarify is you wish.
What is your gender/sex? Select the gender you most identify with.
Are you currently pregnant? What trimester are you in? Are you currently post-partum, lactating, or trying to conceive? Check all that apply.
Do you have a diagnosed health problem? Please advise if you have been diagnosed with any of the following? Check all that apply.
Please provide any further details if you have ticked any of the above, chosen 'other' or 'Not sure'... A brief description of dates of diagnosis, where the condition is in the body, or the length of time you have been in remission for example.
Do you currently work with a holistic nutritionist, registered dietician, naturopathic doctor or other nutritional practitioner or specialist? Please provide details.
Do you currently take prescription medications? Which prescription medications do you regularly take? Check all that apply.
Please clarify if you have ticked 'other'.
How often do you take OTC (over-the-counter) medication? Such as pain killers or medications for acid reflux.
Please briefly describe any OTC medicines you take.
How often do you drink alcohol? Which alcoholic drink(s) do you favour?
How often do you smoke (includes vaping)? Please give details. How long you smoked for, when you gave up, and a brief description of why you gave up.
When was your last check up or medical? Please provide any relevant information. If you had low levels of a particular vitamin or mineral, if it was advised that you should watch cholesterol levels, make dietary changes, improve cardiovascular health, etc.
Blood testing Blood testing can be a useful indicator of current health and also identify vitamin and mineral deficiencies. I do not advise taking specific supplements, such as vitamin D or omegas unless a blood-work test highlights a need to take them.
I work with Thriva, an established and reputable company, that provides home-based testing kits. Your results will be private and discussed with you only by a qualified GP.
Your work life. This section looks at other factors that affect health and fitness are those like stress, social support, and time spent on work, family, and other responsibilities.
Are you currently working? What do you do for a living?
What time of day do you primarily work? Choose the answer that best applies.
Please give a brief description of your shift work.
How many days a week do you work from home on average?
What's your activity level at work? Choose the answer that best applies.
What's your activity level when working from home? Choose the answer that best applies.
How would you describe your daily activity outside of exercise? Choose the answer that best applies.
What is your typical stress level at work? 1 = no stress at all, 10 = the most stressed you've ever been.
Is traveling around the country or abroad part of your job (outside of any current restrictions)? How often would this be? Choose the answer that best applies.
Does your employer offer a wellness programme? Would participation in this coaching program give you credit towards any incentives? For example, does your additional activity give you points towards any benefits or bring medical/life assurance costs down?
Does your wellness programme provide access to live exercise classes that you can participate in with colleagues or teams from home? Would you be interested in hearing more about classes you could do online with colleagues? Would you be interested in hearing more about access to live exercise classes that you can participate in with colleagues or teams from home? Home Life Are you in a committed relationship? Do you have any children and/or step children? How many children and/or step children do you have? What is your typical stress level at home? 1 = no stress at all, 10 = the most stressed you've ever been.
For all your lifestyle-related stressors, how well do you cope with stress? Choose the answer that best applies.
Personal information consent 1. The Compound Club Ltd Ta. Boxing, Bars & Bells does not share or sell your information. The only person who will have access to your data are you and your coach, James Toff.
2. It is up to you to decide what and how much data you provide. You can share everything with or provide very little information, depending on how much information you wish to divulge and how much you think this will help your progress. You can write your life story or simply type 'N/A' if you don't wish to share some information. If you have concerns, please request a discussion and agree on how much information you are willing and able to share.
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3. The information you can choose to share includes: measurements, photos, and information about your health, race and ethnicity, personal history, and family and professional details. Your privacy is paramount and all of your data, including your images, is encrypted. Your information will not be shared with any third parties.
The Compound Club Ltd Ta. Boxing, Bars & Bells has the right to store and process any information I provide and will not share any information with anyone else.
The Compound Club Ltd TA Boxing, Bars & Bells has the right to store and process any information I provide and will not share any information with anyone else.* Please sign if you consent.
Medical release Every individual who has taken part in an online coaching program with The Compound Club Ltd has improved their health and fitness in some way.
A key part of that is that every client takes full responsibility for their health and the monitoring of it.
It's important that you understand:
1. Any advice you receive does not replace the advice of a trained medical doctor.
2. It is your responsibility to work directly with your physician before, during, and after seeking coaching with The Compound Club Ltd.
3. If you choose to be coached The Compound Club without prior consent of your physician, you agree to accept full responsibility for your decisions and to hold harmless The Compound Club, James Toff, and any affiliated companies from any liability with respect to injury to you or your property arising out of or connected with your use of the information discussed.
Medical release.* Please sign if you consent.
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