1-2-1 Consultation Form
Coach Moassab
Full Name
*
First Name
Last Name
Phone Number
*
Please enter a number you would like me to contact you on
Email
*
Please enter an email you would like me to contact you on
Instagram handle
*
Date of Birth
example: 01/01/2022
What is your goal and why?
Are you currently doing some form of exercise? If so, what are you currently doing?
What time do you prefer to train?
Morning/Afternoon/Evening
List any medications you are currently taking
N/A if you’re not taking any
Have you been diagnosed with any health problems?
Do you currently smoke?
What’s your current diet like?
Please be honest about this
Have you ever tracked calories? If yes, how does it make you feel?
What are your expectations of me as a personal trainer?
Why have you decided to choose me as your personal trainer?
Please be honest about this. Just want to know what made you come to me as opposed to someone else so there’s no right or wrong answer
How many personal training sessions would you like to do per week?
When would you like to start?
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Day
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Month
Year
2 digit day, 2 digit month, 4 digit year
Additional Information/Comments
SUBMIT
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