Goal Setting Form

1
Which location are you interested in?
Bingley Barbell Club, Bingley
I want remote/ online coaching
2
Name* This field is required.
First Name
Last Name
3
Email* This field is required.
example@example.com
4
How long have you been wanting to make changes to your lifestyle?* This field is required.
6 months
1-2 Years
2-4 years
5 years +
5
How important is it for you to make these changes?* This field is required.
1
2
3
4
5
6
7
8
9
10
Not right now
Extremely important
6
Have you ever set your own goals before and if so, what were they?* This field is required.
7
Did you achieve them?* This field is required.
Yes
Got some results
No
8
When working towards your goals what were the main barriers you had to overcome?* This field is required.
• Time?
• Knowledge?
• How to apply the knowledge?
• Motivation?
• Unsustainable process?
• Social life / work lifestyle?
• Family?
Other
9
How would you rate your current daily activity levels?* This field is required.
• Sedentary – (Little to no daily walks, desk job little to no exercise)
• Lightly active (Lightly active plus exercise 1-3 times per week)
• Moderately active (Moderate daily walks/activity plus exercise 3-5 times per week)
• Very Active (Highly active with walks/daily activity and exercise 5-7 times per week)
10
How would you rate your current nutrition?* This field is required.
1
2
3
4
5
Shocking really needs to improve
I'm doing everything right
11
Explain in more detail why you have chosen that number?* This field is required.
12
How do you feel this is holding you back from achieving your goals?
Huge
Large
Normal
Small
Ok
Ok
13
What is your present exercise experience?* This field is required.
• Use fixed pin weight machines
• Use free weights
• Use cardio kit
• Use classes
• Daily walks
• Home workouts
Running
Other
14
When it comes to the gym, exercise and movement, what do you enjoy to do?* This field is required.
15
What do you find you dislike and don't enjoy and why?* This field is required.
16
If there was nothing holding you back what would you really love to do?Could be a competition, hyrox, hitting a certain PB, running a race, dancing etc
Huge
Large
Normal
Small
Ok
Ok
17
When it comes to trying to achieve your goal, what do you feel like you need support with most?* This field is required.
Accountability - Constant confirmation you're doing the right thing
Structure - What to do and when to do it
Education - Knowing why and how to apply the principles into your life
Motivation - Have someone to support you through the process
Staying consistent - Support to overcome barriers
Other
18
In your words what are the main outcomes you would like to achieve from having personal coaching?* This field is required.
19
How long do you think it will take you to achieve that?* This field is required.
6 Months
9 Months
12 Months +
Other
20
Do you want to add anything else you feel would benefit my understanding of you and what you want to achieve?* This field is required.After submitting this form, I’ll be in touch and you'll receive an email from me so keep an eye on your junk!
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