Initial Consult Form

Initial Consult Form

The Purpose of this form is to assess whether you will be a suitable client, find out what service is best for you, and make a enquiry. Once you have completed this form i will contact you via email, instagram or phone.
Name
Contact Number
Age
Email
Emergency Contact
Occupation
General Health

Please Fill to the best of your knowledge
Current Weight
Height

Please Answer Yes or No

Rows	Yes	No
Do you have any current health issues that are a concern to you?
Have you been hospitalised recently?
Have you had any major health concerns in the past?
Do you lose balance due to dizziness or lose consciousness?
Do you have Bone or joint problems that could be worsened by participating in physical activity?
Are you on any prescription medication from your doctor?
Do you know any other reason why you should not do physical activity?
Do any of the following apply to you: endometriosis, Pcos, irregular periods, hysterectomy, loss of libido, painful periods, severe pms,

If you answered yes to any of the above, please provide details
Do you smoke? If yes, how often and how much daily
Do you drink alcohol? If yes, how often
Lifestyle

Please fill to the best of your knowledge
Is your menstural cycle regular? How many days is your cycle? Are you on any form of birth control?
Have you tried to change your body composition in the past or improve strength? Please provide details
What specifically would you like to achieve working together?
On a scale of 1 - 10 how would you rate your current sleep? What time typically, do you fall asleep and what time do you wake up?
On a scale of 1 -10 how would you rate your energy levels throughout the day? When are you at your lowest energy level?
On a scale of 1 - 10 rate your stress levels throughout the day? When do you feel you are most stressed and what causes it?
What do you do for work? How long have you been doing this job for and are you willing to incorporate a training regime into your weekly schedule?
How many hours a day are you seated?
where do you find you store majority of body fat? And where do you feel you need to lose most?
What is your body composition goal? Is this a short term goal or long term goal?
Nutrition

Please fill this to the best of your ability
Please provide information your current daily eating/typical daily meals. Guess if not sure, but note this is just a estimate
Fluids consumed throughout the week (i.e alcohol, water, coffee, soft drink) how much daily?
Do you have any times of the day you struggle to eat or would clash with your usual eating pattern?
Do you have any food allergies or sensitivities to food? (Gluten, wheat, seafood, nuts, or coeliac)
Are you vegetarian or vegan?
Is there any foods you dislike or prefer not to eat?
Do you suffer from any of the following symptoms? (Bloating, gas, cramping, headaches, fatigue, skin irritation, poor memory, GERD, loose stool, or any other gut related issues)?
Do you currently take any supplements? What type and dose?
Have you followed a nutrition plan before? What type and did you find it easy to stick to?
Any Prescription medication? What type and dosages? Reason currently why you are on this medication? How long?
Training

Please fill to the best of your knowledge
Are you currently physically active? If yes what type of activity? (Weights, walking, running, swimming, yoga)
Have you done weight training previously? If yes where? (Gym, personal training, boot camp, group classes)
What type of exercise do you enjoy?
Have you had a personal trainer before? If yes, how long for?
As your trainer what do you expect from me?
Do you have any concerns or questions for me before we start?
Mindset

How committed are you to transforming into a healthier and fitter version of yourself?

	1	2	3	4	5	6	7	8	9	10

1 is Doesn't bother me, 10 is Very committed

Rate your level of knowledge when it comes to nutrition

	1	2	3	4	5	6	7	8	9	10

1 is complete beginner , 10 is expert

Should be Empty:

Initial Consult Form

General Health

Lifestyle

Nutrition

Training

Mindset