Mentorship Application Name * First Name Last Name Birthdate * MM DD YYYY Exercise Experience * None New Intermediate Advanced Professional ( Personal Trainer, Strength Coach, Kinesiologist, Physical Therapist, Exercise Scientist) Chronic Pain? * No pain Neck/Shoulders Lower Back Hips Knees Ankles Acute injury (sprain, tear, etc) Other Do you have a medical condition that could put you at risk during exercise? * Yes No Do you have any apparent postural misalignments? * My posture is aligned Forward Head Slouched shoulders Elevated shoulder Forward rotated hip Elevated hip Knock knees Bowed legs Flat feet Other Workout Space * Where will you exercise? Commercial Gym School Gym Apartment Block Gym Athletic Centre Home Office Outside Goals * What do you seek out of exercise? How long have you been actively taking care of your body * Never Recent 1-3 years 3-5 years 5 years + Have you worked with an exercise professional before? * How's your sleep quality? * Excellent Good Average Bad Terrible How would you rate your energy levels throughout the day? * High Consistent Average Inconsistent Bad Always Lethargic What's your schedule like? * What has or has not worked well for you before? Do you have any concerns regarding exercise? Monthly Exercise Budget * $/month (Excluding food) Not comfortable disclosing this information 1000$+ 500$-1000$ 300$-500$ 100-300$ 50$-100$ 30$-50$ >30$ Thank you, we will process your information and get back to you shortly with the next phase.
