COACHING FORM - NEBULA COACHING

1
Full name* This field is required.
First Name
Last Name
2
What is your Address?* This field is required.Insert full address and Eircode/Postcode.
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
3
Phone Number* This field is required.Jot down your number below..
4
Email* This field is required.
example@example.com
5
Which of our services are you most interested in?* This field is required.At your consultation we will refer you to the one which will suits your needs best.
Online Virtual Based Personal Coaching through our 1:1 App
Small Group Training (Cobh Gym)
Small Group Training (Bishopstown Gym)
6
Where did you hear about us?Have you come as a referral, from a physio or through social media?
Huge
Large
Normal
Small
Ok
Ok
7
Have you even been in a gym before?* This field is required.
YESNO
8
Have you worked with a Personal Trainer Before?* This field is required.
YESNO
9
Have you ever worked with a Personal Trainer online?* This field is required.
YESNO
10
Which of the below do you think needs improvement?* This field is required.
Training Structure
Recovery
Nutritional Understanding
Sleep Improvement
11
How well do you take instruction?* This field is required.
No Problem Following Instruction
Pretty Good
Not Very Well
Nobody Can Tell Me What To Do
12
How would you rate your self-initiative?* This field is required.
"Very Poor"
"Ok I guess"
"I can overcome any obstacle"
13
How important is it for you to create change?* This field is required.
1
2
3
4
5
Kind of..
Completely...
14
How long have you been thinking about getting into some fitness (or changing who you do your fitness with)?* This field is required.
Less than 1 Month
1-3 Months
3-6 Months
6-12 Months
1-3 Years
3 Years+
15
What has stopped you from taking action?* This field is required.What is the thing that you think gets in the way the most?
Energy
Time
Money
16
Is this resolved or almost resolved?* This field is required.We presume so, seeing as you are taking this action today!
YESNO
17
When was the last time you quit/gave up on something and why?* This field is required.Not strictly fitness.
Huge
Large
Normal
Small
Ok
Ok
18
Outline your main goal, your main reason for being here?* This field is required.I want to be/feel/do...
19
Do you have a timeline to achieve your goal?* This field is required.If not is it more of a lifestyle change maybe?
20
Tell us how you envisage going about your goal...* This field is required.Include numbers of trainings per week, the intensity you will work to, the time of day that you plan to train and the lifestyle changes you need to make now to help yourself.
Huge
Large
Normal
Small
Ok
Ok
21
Of the Below, what is the most important for you?* This field is required.
Community feel
Intense training
Coaching
Support & Guidance
Motivation
Results
Other
22
What Training Equipment do you have at your disposal?* This field is required.If you plan on training in a large commercial gym then simply write "gym".
Huge
Large
Normal
Small
Ok
Ok
23
A bit about us... We are Kate & Adam. We are comfortable saying that we are the most qualified, experienced and friendliest coaches that you will ever meet. We lead by example, set the standard and push you to be better than yesterday. All we look for is a big slab of hard work, perseverance and openness to learn.
24
Please suggest 3 days & times that you will be able to take a phonecall.* This field is required.E.G. Tuesday Afternoon
Huge
Large
Normal
Small
Ok
Ok
25
Are you ready to take action and make a decision that will improve your health, fitness, performance and life?* This field is required.
YESNO
Should be Empty: