Personal Training / Online Coaching

Name

First NameLast Name

Email

example@example.com

Phone Number

Format: (000000000000.

Please state your age, weight and height. (If known)

This can be an estimate if you don't have scales.

What do you do for a living and what is the activity level at your work? - none (seated only) - moderate (light activity such as walking) - High (heavy labour, very active)

Add brief description.

Please list the physical activities that you participate in outside of the gym and outside of work.

Do you follow a regular working schedule, do you work days, afternoon or nights?

If you have any diagnosed health problems please list the conditions.

If you are on any medications, please list them.

If you have any injuries please list them.

Be specific.

Are you experiencing any stress or motivational problems?

Has anyone of your immediate family developed heart disease before the age of 60?

Do any diseases run in your family?

How long would your ideal session take?

Do you suffer from diabetes, asthma, high or low blood pressure? If yes please list :

Are your a current smoker?

Thc and/or tobacco.

To give me an understanding of how many calories you are currently on, please give me an average breakdown of your daily food intake :

Breakfast - lunch - dinner and all snacks, sugary drinks, coffees.

Please state foods you like.

Please state foods you dislike and any allergies.

Where do you do your shopping?

Which of the following goals best fit in with your goals?

What is your goal with your training? And list any areas/body parts you wish to focus on.

How many days are you willing to train?

Have you trained with a personal trainer before?

If yes what kind of training did you do.

At what time of the day would you prefer to train?

How often a week do you want personal training? (If online coaching leave blank)

What are your expectations of me as your personal trainer?

What gym will you be training at? If restricted to home workouts please not down specific equipment and weight.

What kind of bands, weights of kettlebells/dumbbells.

Please rate your readiness to change on a scale of 1-10

Transformation to do list : -

- Take and send 3 pictures of yourself. One from the front, rear and side (pictured)

- Send through your weight

- Measure your waist, below belly button, right arm and right leg (biggest part)

PLEASE READ THE FOLLOWING T&C's.

1.) CANCELLATIONS

Cancellations should be made at least 24hours in advance of a scheduled session. Sessions can-celled less than 24 hours in advance will be charged in full to the client.

2.) LATE ARRIVALS

Each session will be up to 1 hour in length. Sessions will not be extended (unless time is available) due to the lateness of the client or due to interruptions caused by the client.

3.) ALL THE INFORMATION I HAVE GIVEN IS CORRECT

All the information on this form is correct and to the best of my knowledge. I have sought and fol-lowed any necessary medical advice. I understand that all the information given will be kept confi-dential.

4) REFUNDS

No refunds are giving after the first session is complete (includes block bookings ). After the session all sessions must be used up within 3 months.

5) PHOTOS

Before and after pictures can be posted online to support the business however face can be cut out on request also don't need to be tagged or named.

I AGREE TO THE ABOVE TERMS & CONDITIONS!

Date

Signature

File Upload

Personal Training / Online Coaching Consultation Form