FitSELF Lifestyle Questionnaire

1
What is your full name?
First Name
Last Name
2
What's your date of birth?
Date
Day
Month
Year
3
What gender do you identify as?
Male
Female
Non-binary
Other
4
What's the best phone number to contact you on?
5
What is your email address?
example@example.com
6
What is your Facebook ProfileCopy and paste the Facebook URL here
7
What is your occupation?
8
What are your PRIMARY goals that you'd like to achieve from a new fitness program?Choose as many as you'd like
Lose Fat
Gain Muscle
Improve Health and Longevity
Improve Productivity and Work Focus
De-stess and Improve Mindset
Other...
9
What best describes where you're at right now in terms of your fitness?Pick one that is the best or closest fit
I don't know where to start
I have started but I have reached a plateau
I need accountability and guidance
I know what to do, but it's taking too long by myself
Other
10
What has stopped you from reaching your goals so far>Choose as many as you'd like
Lack of Knowledge
Lack of time
Lack of commitment/motivation
Lack of accountability
Other
11
Which of these describes your biggest goal THIS year?
Get in the best shape of my life
Be the healthiest version of myself
Use this journey to gain confidence
Find a better balance between a healthy lifestyle and work load
Stop procrastinating and make my fitness and health a higher priority
12
Why NOW? What has prompted you to make this enquiry or get in touch with me?
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13
Are you currently performing ANY regular exercise?
YESNO
14
If yes, briefly outline what that is and how often on a weekly basis?
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15
Have you ever worked with a Trainer before?
Face-to-Face PT
Online Coach
Both
Neither
16
If so, what did you enjoy, or not enjoy, the most?
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17
How much were you investing in this service on a monthly basis?
18
Briefly describe a typical day's food intake broken down by meal - e.g. breakfast, lunch, dinner, snacks, etc. (feel free to be as detailed as possible)
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19
What is your average weekly alcohol consumption (if any)?
20
Do you smoke?
Yes - more than a packet/day
Yes - less than a packet/day
No - never have
No - ex-smoker
21
How would you rate your motivation?
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2
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9
10
Poor
Highly motivated
22
Briefly outline why you rated your motivation that way.
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23
How determined are you to suceed on this journey?
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10
Not very
I'd do ANYTHING ..!
24
What's the driving factor behind that?
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25
How much would you be willing to invest in your health and fitness OR to achieve your goal if you know you would 100% achieve it?
Up to £100/month
£250-£350/month
£500+/month
26
What would success look or feel like 12 months from now? (e.g. weight, mindset, habits, appearance, etc.)
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27
Is there a specific time frame to achieving these goals for you? If so, when do you want to get started?
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28
In a lengthier paragraph, is there anything about you that you think could give me a better idea of your journey so far, where you want to get to and why?
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29
Other than the obvious physical transformation you are looking for, what other value will this journey add to your life - e.g. relationship, confidence, more productive at work, etc?
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30
Thanks for completing the questionnaire. At this point I'd recommend we arrange a call to discuss your goals further and see if we are a good fit for each other. Would this be of interest to you?
Yes, I'd like to arrange a call
No thank you
Type option 3
Type option 4
31
That's great!!

Simply click on the link below and select a date and time that suits you best.

I look forward to speaking with you very soon!

Brad

CLICK HERE TO BOOK YOUR CALL
32
OK, that's cool.

Be sure to click on the SUBMIT button below.

I'll be in touch soon to discuss next steps if I believe you'd be a good fit for my program and that you'd get the results you were looking for.

Brad
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