Fernz Fitness
Hello there! If you are interested in becoming a client, fill out the questionnaire below and I will get in touch with you to cover everything. Let's achieve your goals together as a team.🤜🏻🤛🏻
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Gender
*
Male
Female
Date of birth
*
-
Month
-
Day
Year
Date
Age
*
Height (cm)
*
Weight (kgs)
*
Job Description
*
Do you have any medical conditions? If so, please state.
*
If you are on any medications, please list them.
*
If you have any injuries, please list them.
*
Are you experiencing any stresses or motivational problems?
*
Yes
No
Are you a smoker
*
Yes
No
In your own words, give me as much information as possible about your current eating habits.
*
What are your short-term goals?
*
What are your long-term goals?
*
Do you have a set time frame for when you want to achieve your goal?
*
Rows
6 weeks
8 weeks
12 weeks
6 months
1year
Select
Have you exercised regularly in the last 2 months?
*
Yes
No
Have you trained with a personal trainer/online coach before?
*
Yes
No
What are your expectations from me as your Online Coach?
*
Submit
Should be Empty: