Consultation Form
****YOUR INFORMATION IS NEVER GIVEN OUT OR SHARED **** Questions with an * require a response, nil or n/a can be used if you have no response.
Name
Email
What do you want to achieve, what is you dream goal?
500
Are you ready to change to achieve your goal?
Select an option
Yes
No
Exercise and Availability
Are you currently / have you exercised regularly in the past?
Select an option
Currently exercise regularly.
Have in the past but not now.
Have not exercised regularly.
Briefly explain either what you are doing or have done in the past.
300
Rate your ability to perform exercise?
Select an option
Very Low
Low
Average
Good
Very Good
What equipment do you have access to?
Home Gym
Commercial Gym
None
Name of your Commercial Gym OR give a description of the Home Gym equipment you have access to? (inc. Kettle Bells, Bands, How much weight you have, etc)
500
Which days are you available to workout?
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
What time on these days can you train?
Morning before 9am
During the day, 9am-5pm
Evening, after 5pm
Give specific times if needed?
200
Are there any time restrictions on how long your work out can be? (If yes then explain below)
75
How demanding is your work?
Select an option
Low
Moderate
High
Not Applicable
Give a brief description of your working day.
500
Give a brief description of a day off.
500
Diet Related Questions
Honesty is the best policy here.
What do you have for breakfast?
100
What do you have for lunch
100
What do you have for dinner?
100
What do you have for snacks?
100
List all the healthy whole foods you like to eat regularly?(Lean meats, vegetables, fruits etc)
500
Now list all the other foods you like to eat?(Don't hold back)
500
How often and how much alcohol do you consume?
Medical and Health Related Questions
All questions in this section require a response.
Do you have any existing or past injuries that impact your ability to exercise?
300
Do you have any mobility or movement issues that impact your ability to exercise?
300
Any medical conditions existing or past that I should be aware of and/or need medical approval for to exercise?
300
If any, what medications do you currently take?
300
Do you smoke tobacco or vape?
Select an option
Yes
No
Once submitted a link to book your free consult call will be emailed to you. If we have already your consult call please disregard the email.
Ensure everyone involved in the decision process can be present for the call as its an important decision. If you can not see it please check your spam/junk folder.
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