PT & Online Coaching Form

1

Full Name* This field is required.

First Name

Last Name

2

Gender* This field is required.

Male

Female

Non-binary

3

Age* This field is required.

years

4

Height* This field is required.

cm

5

Weight* This field is required.

kg

6

City/town* This field is required.

7

Email* This field is required.

8

Mobile Number* This field is required.

9

Instagram Handle* This field is required.

10

What is your occupation?* This field is required.

11

What is your physical activity level right now?* This field is required.

Low (seated mainly)

Moderate (light activity - walking)

High (very active - exercise at least 4x a week)

12

Please tell me, in as much detail as possible: 1) What your goal is 2) Why this is important to you?* This field is required.

13

What are you struggling with right now?* This field is required.

What have you been trying? What are you working towards. that you feel you aren't achieving?

14

In a "best case" scenario, and everything went to plan, where exactly do you want to be 3 months from now?* This field is required.

E.g. I'd like to have lost 10kg, be able to fit into my clothes better, not feel embarrassed when I take my clothes off, have more self confidence in my appearance, and feel happy about my body image.

15

Which of the following appeals to you?* This field is required.

Lose body fat and get leaner

Gain muscle mass

Improve self confidence (body image/mentally)

Gain education around Nutrition and Training

Receive personalised coaching to fast track your results

Other

16

On a scale of 1-10 how committed are you to making a serious change to your life?* This field is required.

1-3

4-7

8-10

17

Do you have any health/medical conditions or injury which would affect your ability to exercise? Please include any prescriptions also.* This field is required.

E.g. high blood pressure, arthritis, birth control pills etc.

18

Voucher Code

19

What service are you interested in signing up?

1-2-1 Personal Training

Online Coaching

I want to enquire both options

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To discuss everything in more detail and in the most efficient way, would you be available for a Facetime/Whatsapp video? We will also go over your best plan of action moving forwards.* This field is required.

Yes

No

21

Please allow 24 hours for a response. Make sure to keep an eye in your junk mail just incase!* This field is required.

Got it!