PERSONAL TRAINING AND ONLINE COACHING PRE-CONSULTATION FORM
Name
First Name
Last Name
Email
example@example.com
How long have you been wanting to make changes to your lifestyle?
0-6 Months
6-12 Months
1-3 Years
3+ Years
Have you ever set your own goals before and if so, what were they
Did you achieve you goals
YES
NO
PARTIALLY
When working towards your goals what were the main barriers you had to try to overcome? (Tick all that apply)
Lack of time
Lack of knowledge
Inability to apply knowledge
Lack of motivation
Work commitments
Family/ Social commitments
Other
If other was ticked please elaborate
How would you describe your current activity levels
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)
How would you rate your current nutrition
Terrible
Closer to bad than good
Not too bad through the week but go mad on weekends
Pretty good most of the time but not seeing results
Great, understand calories know what and how much to eat
Explain in details why you have chosen that option
What is your present training experience (pick all which apply)
Daily walk/ run and that's about it
Home workout (body only)
Home workout (equipment)
Attend Gym classes
Use Cardio machines
Use machines at the gym
Use free weights
When it comes to the gym, exercise and movement, what do you enjoy to do?
What do you find you dislike and don’t enjoy?
When it comes to trying to achieve your goal, what do you fee like you need support with most?
Accountability (confirmation you are doing the right thing)
Structure (what to do, how to do it 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)
In your words, What are the main outcomes you would like to achieve from working with a professional (either online or in person)
How long would you say you expect to achieve that?
0-6 Months
6-12 Months
1-3 Years
3+ Years
What type of coaching are you interested in to reach your goals
Online coaching only
In person personal training
Do you want to add anything else you feel would benefit my understanding of you and what you want to achieve?
Submit
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