Start Your Assessment | Phase Coaching

Step 1: Assessment 10 minutes

You Are Here

A questionnaire covering your training history, goals, nutrition, and lifestyle. Everything I need to understand your situation before we connect.

Step 2: Consultation 30 minutes

I'll review your answers, and we'll set up a time to meet. During this consultation we'll talk through your goals and what's been getting in the way.

Workout (in person) 45 minutes

For in-person clients, we'll also go through a workout so I can see your movement, strength, and conditioning firsthand.

Step 3: Coaching

After our consultation, I'll give you a recommendation tailored to what I learned about you. You can take the recommendation and apply it to your own training, or if it's a good fit, we continue with coaching.

Don't fill this out:

Basic Info Step 1 of 6

Basic Info

Full Name *

Email *

Phone Number *

Are you filling out this form on behalf of a minor or other participant? *

Participant's Full Name *

Participant's Date of Birth *

Age *

Height *

Weight *

Biological sex * Male Female Prefer not to say

How did you find me? * Instagram Google Referral from someone I know Los Campeones Gym Hyrox website Other

Goals

What is your primary fitness, nutrition, or performance goal? *

Why do you want to achieve this goal? And why is that important to you? *

What does success look like for you one year from now? *

What are your biggest obstacles in achieving this goal right now? *

On a scale of 1-10, how motivated are you to achieve this goal? *

1 2 3 4 5 6 7 8 9 10

What date would you like to achieve this goal by? *

What is your specific target goal weight or body composition change (if applicable)?

What other secondary fitness goals do you have, if any?

Training History

What is your biggest current challenge when it comes to training? *

How would you rate your current training level? * Novice: You've never been on a structured training program Beginner: You've been on a structured training program for less than 6 months. Intermediate: You've been on a structured training program for more than 6 months, made your beginner gains, and now progress has slowed down. Advanced: You've been on a structured training program for several years, have navigated the challenges of intermediate training, and know your body and training very well. Progress is hard to come by.

What sport(s) do you currently train for, compete in, or have a background in? *

Have you participated in a structured training program before? If so, describe it. *

Have you worked with a personal trainer or strength coach before? * No Yes

If yes, briefly describe the experience.

What kind of training do you currently do? *

How many days per week are you currently training? * 0–1 days 2–3 days 4–5 days 6+ days

Do you have any current or past injuries? If yes, please describe and note if it limits any movements.

Are you currently experiencing any aches, pains, or discomforts during specific movements?

What does your training setup look like? * Full commercial gym (barbells, racks, machines, cables) Home gym — mostly free weights / barbell Home gym — dumbbells, bands, limited equipment Bodyweight / minimal equipment only Other

Anything specific about your setup I should know?

Nutrition History

What is your biggest current challenge when it comes to nutrition? *

Are you following a specific diet or nutrition plan? Please describe it below. *

How would you rate your experience with Meal Planning? * Meal planning is creating a menu based on portions or macros. Not Experienced Somewhat Experienced Very Experienced

How would you rate your experience with Meal Prep? * Meal prep is cooking according to your meal plan, including cooking in bulk. Not Experienced Somewhat Experienced Very Experienced

How would you rate your experience with Meal Tracking? * Meal tracking is logging food eaten, including macros. Not Experienced Somewhat Experienced Very Experienced

How would you rate your ability to adhere to a meal plan? * It's usually very difficult for me It's usually on / off I usually am able to follow a plan closely without falling off

Do you have any known food allergens, intolerances, or dietary restrictions?

Are you currently taking any supplements? Please list them below.

Lifestyle Factors

These questions address the external factors that significantly impact training, recovery, and adherence.

What is the biggest lifestyle challenge you are facing right now keeping you from your fitness goals? *

What is your current occupation? * e.g. Desk job, physically demanding labor, flexible schedule

What is your typical weekly availability for working out? * e.g. Mornings before 9 AM for 30m, Tues/Thurs after 5 PM for 1hr, Weekends open.

On average, how many hours of sleep do you get each night? How is your sleep quality? *

How would you rate your current stress level from 1-10? What are the major sources of stress in your life right now? *

How often do you drink alcohol? * Never Occasionally (a few times a month or less) Weekly (1–2 times a week) Frequently (3+ times a week)

Do any of the following apply to you?

Heart Disease / Stroke High Blood Pressure Diabetes Weight Loss Surgery Previous or Current Eating Disorder Thyroid Cancer / Hypothyroidism / Hyperthyroidism Pregnant / Breastfeeding Osteoarthritis PED or HRT use

What level of coaching are you most interested in? *

Online

Programs 1:1 Online Coaching

In Person (Round Rock, TX area)

1:1 Sessions Semi-Private Sessions Hyrox Classes

Is there anything else you think I should know about your health, lifestyle, or past experiences that might affect your training?

Health & Waiver

The following 7 questions are a standard health screening (PAR-Q). Please answer each one honestly. If you answer Yes to any question, consult your physician before starting any exercise program. You can still complete this assessment.

1. Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor? * No Yes

2. Do you feel pain in your chest when you do physical activity? * No Yes

3. In the past month, have you had chest pain when you were not doing physical activity? * No Yes

4. Do you lose your balance because of dizziness, or do you ever lose consciousness? * No Yes

5. Do you have a bone or joint problem (for example, back, knee, or hip) that could be made worse by a change in your physical activity? * No Yes

6. Is your doctor currently prescribing medication for your blood pressure or a heart condition? * No Yes

7. Do you know of any other reason why you should not do physical activity? * No Yes

Release and Waiver of Liability

Because physical exercise can be strenuous and subject to risk of serious injury, Jason Dupree d/b/a Phase Coaching ("Coach") urges you to obtain a physical examination from a doctor before beginning any exercise or training program.

You agree that by participating in physical exercise sessions, personal training activities, or following any programming or instruction provided by Coach, whether delivered in person or remotely through online coaching, digital programs, video, or written instructions, you do so entirely at your own risk. This includes, without limitation: (a) your use of any facility, equipment, or training space, including your own home or training environment, and your participation in any activity, class, program, personal training, or instruction; (b) the sudden or unforeseen malfunction of any equipment; (c) instruction, training, supervision, coaching, or nutritional recommendations provided by Coach, whether in person or through any remote or digital means.

You agree that you are voluntarily participating in these activities and assume all risks of injury, including but not limited to injury resulting from ordinary negligence. You expressly agree to release, discharge, and hold harmless Jason Dupree and Phase Coaching from any and all claims or causes of action arising out of participation in coaching, training, or programming services. This release does not extend to claims arising from gross negligence, willful misconduct, or intentional acts.

If any portion of this release from liability is deemed invalid by a court of competent jurisdiction, the remainder shall remain in full force and effect.

You acknowledge that you have carefully read this waiver and release, fully understand its contents, and voluntarily agree to be bound by its terms. You agree to give up any right you may otherwise have to bring a legal action for ordinary negligence or other personal injury or property damage arising from participation in coaching services.

This agreement is governed by the laws of the State of Texas.

Full Name (electronic signature) *

Date *

I have read and fully understand this Release and Waiver of Liability. I voluntarily agree to its terms. Checking this box and typing my name above constitutes my electronic signature. *

Submission failed. Check your connection and try again.