Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Instagram Handle Or Mobile Number
Instagram Handle or Mobile Number
*
This is so I can reach out to you
Mobile Number
-
Area Code
Phone Number
How Did You Find Out About Us?
*
ie. Instagram, friend
What Are Your Current Health Goals?
*
Development of muscle
Reducing stress
Losing body fat
Increasing motivation
Training for an event/specific sports
Mental Health/Feel Good
To Feel Fit and Healthy
Build strength
I want to follow a structured program
Other
What Coaching Are You Interested In?
*
1:1 Premium Online Coaching
Online Nutrition Coaching
In Person Personal Training (Melbourne Only)
Unsure, Send Me The Breakdown
Tell Me Why You Want To Get Started?!
*
ie. I want to feel on top of the world again
What Type Of Coaching Are You Looking For?
*
Face to Face PT
Full Online Coaching Package
Nutrition Only Coaching
Combination of the Above
General Health & Lifestyle Questions
*
Rows
Yes
No
Are you using any additional vitamins or supplements?
Have you had a coach/trainer before?
Are you currently tracking your food intake?
Are you following a structure training program?
Do you experience pain whilst exercising or have an existing injuries?
How Would You Rate Your Current Health On A Scale of 0-5?
*
0
1
2
3
4
5
TERRIBLE
AMAZING
0 is TERRIBLE , 5 is AMAZING
How Important Is It For You To Start/Continue Your Journey?
*
0
1
2
3
4
5
I do not care at all
I am prepared to do what it takes
0 is I do not care at all , 5 is I am prepared to do what it takes
How Many Days Are You Prepared to Commit to Exercise Per Week?
*
How much are you willing to invest into your health & fitness per week?
*
$40-50
$50-70
$70-$100 per week
Other
Are You Willing To Commit to Investing In Yourself? N.B: Coaching services start from a min. of $60 per week
*
YES - Absolutely
No - Not Yet
Please Explain Why You Are Looking To Work With Me?
*
What Is The Best Way To Reach Out To You?
*
Text Message
Phone Call
Instagram/TikTok
WhatsApp
Email
Today’s Date
*
.
Day
.
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Your Signature
*
Submit
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