SCULPT+ Pre-Consult Form
This is more of a in-depth form for me to understand you more and what you want to achieve. The accuracy of this is vital so I know if I can provide you with the right service that is going to get you life changing results. Please take some time to fill this form out with as much accuracy as possible. *PLEASE NOTE* After you have submitted this form it will direct you to a link so you can book your free 1:1 consultation with myself.
Name
*
First Name
Last Name
Email
*
example@example.com
Age
*
How did you hear about me and my services?
Gym floor
Instagram
Email
Referral from a friend
Other
How long have you wanted to make changes for?
6 months
1-2 years
2-4 years
5+ years
How important is it to make these changes?
Not right now
1
2
3
4
Extremely Important
5
1 is Not right now, 5 is Extremely Important
Have you ever set your own goals before and if so, what were they?
if so did you achieve them?
yes
no
got some results
When Working towards your goals, what barriers did you have to overcome?
Time
Motivation
knowledge
work
Family
Social life
Other
How would you rate your current daily activity levels?
sedentary (little to no daily walks, little to no exercise)
Lightly active (1-3 days of exercise per week)
Moderately active (exercise 3-5 days per week including daily walks)
Very active (highly active with walk, daily activity and exercise 5-7 days per week)
How would you rate your current nutrition?
Really needs to improve
1
2
3
4
Bang on, smash it.
5
1 is Really needs to improve , 5 is Bang on, smash it.
Explain In more detail what your current situation Is like with nutrition?
What is your present Gym experience?
used fix pin weight machines
use free weights
use cardio machines
classes
daily walks
home workouts
When it comes to the gym, exercise and movement, what do you enjoy the most?
What do you dislike the most when it comes to exercise and movement?
When it comes to achieving your goal, what do you need support with the most?
Accountability - constant confirmation you are doing the right thing.
structure - what to do and when to do it
education - knowing why and how to apply principles into your lifestyle.
motivation - need someone with you to support you through the process.
staying consistent - support to overcome barriers
In your words, what are the main outcomes you would to achieve from having personal training/coaching/joining the gym?
How long do you think it will take to achieve that?
3+ months
6+ months
1-2 years
2-3 years
5+ years
Do you want to add anything else you feel would benefit my understanding of you and what you want to achieve?
Submit
Should be Empty: