The Uplift Method: Enquiry Form

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Name* This field is required.
2
Email* This field is required.
3
Social Media UsernameSo I can find you on Instagram or Facebook, what's your '@'?
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Age* This field is required.
18-24
25-30
31-35
36-40
41-45
46-50
50+
5
In your words, what are the main outcomes you would like to achieve from training with me?* This field is required.No matter how big or small, get those goals written down
6
When it comes to achieving your goals, what do you feel like you need support with most?What is that you're missing right now to help you get results? Is it accountability, education, support etc.?
Huge
Large
Normal
Small
Ok
Ok
7
Is there you want to add to help me learn a little more about you?* This field is required.Any other relevant info you want me to know to help further my understand about yourself, how I can help or why you want to change your life.
8
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
9
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
10
Have you ever set your own goals before and if so, what were they?* This field is required.
11
Did you achieve them?* This field is required.
Yes
Got some results
No
Other
12
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
Motvation
Unsustainable process
Social life / work lifestyle
Family
Other
13
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)
14
How would you rate your current nutrition?* This field is required.
1
2
3
4
5
6
7
8
9
10
Shocking, really needs to improve
Couldn't be better
15
Explain in more detail why you have chosen that number?* This field is required.
16
What is your present gym experience?* This field is required.
Use fixed pin weight machines
Use free weights
Use cardio kit
Use classes
Daily walks
Home workouts
Other
17
When it comes to the gym, exercise and movement, what do you enjoy to do?* This field is required.
18
What do you find you dislike and don't enjoy?* This field is required.
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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
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