Pre-Consultation Form (PCF)
This form should take roughly 5-15 minutes to fill out, please be as thorough as possible to give me the best chance of understanding your current level and how I can help you to achieve you goal :)
Step 1/5
Personal Details
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Age
*
Occupation
Which City do you live in?
*
How many hours per week do you work? and what format? (e.g. 9-5, 4 on 4 off, differing shifts etc.)
Gender
*
Male
Female
Other
Instagram
*optional*
Height in cm
*
Weight in kg
*
Back
Next
Step 2/5
Your Goals
What are your goals? (Select as many or as few as you like)
*
Lose bodyfat
Gain muscle
Improve fitness
Improve performance
Get stronger
Other
If selected ‘other’ please specify
What is your main goal and why?
*
Please be as detailed as possible and really think about why you have this goal
Do you have a time frame on your goals? and if so, when is it and why?
*
Back
Next
Step 3/5
Your current level/quality of nutrition (no judgements are made, please be as honest as possible)
What current level of nutrition do you see yourself at? (Select as many or as few as you like)
*
I currently/have tracked calories in the past and confident doing so
I currently/have tracked calories in the past and not confident doing so
I have never tracked calories
I have been in and out of different diets
In your own opinion do you tend to consume similar foods every day and at the same time (almost like routine) or is your diet erratic and unpredictable?
Do you have any diet restrictions? (e.g. vegan/vegetarian, any allergies?)
Have you taken any extreme diet approaches in the past? (e.g. extremely low calories, keto etc.)
Do you currently use any supplements or medication?
Yes
No
If selected yes, please list below being as detailed as possible (dosage/brand etc.)
Anything that you would like to add or make me aware of about your nutrition?
Back
Next
Step 4/5
Your current level/type of training (no judgements are made, please be as honest as possible)
What type of training do you currently do? (Select as many or as few as you like)
*
Weightlifting (muscle gain)
Weight lifting (strength development)
Cardio
HIIT
Callisthenics/bodyweight training
Sport
None
Gym class
Other
If you compete in a sport/sports as a hobby or competitive please list below
How many days per week do you currently train?
*
0
1-3
3-5
5+
How many days per week do you want to train that is realistically achievable?
*
0
1-3
3-5
5+
What time of day do you prefer to train?
Morning
Afternoon
Evening
Middle of the night/early hours of the morning
Back
Next
Step 5/5
Support
What is your reason for wanting a personal trainer/nutritionist? What do you think that I can do to help to support you in achieving your goals?
*
Please be as detailed and specific as possible
Have you previously had a personal trainer/nutritionist?
Yes
No
Prefer not to say
If selected yes, please provide details regarding what that experience was like for you? (Was you over/underwhelmed? Why?)
Everything written here is confidential and will not be shared
Do you own bathroom scales?
*
Yes
No
Do you own kitchen food scales?
*
Yes
No
How did you hear about our services?
Submit
Should be Empty: