Name
*
First Name
Last Name
Age
*
Gender
*
Male
Female
Email
*
example@example.com
Instagram Handle
*
Phone Number
*
Height
*
Weight
*
How active are you on a daily basis?
*
Sedentary
Lightly active
Active
Very active
How would you describe your quality of sleep?
*
How many hours of sleep do you get each night?
*
Highest weight in the last 12 months? (KG)
*
Lowest weight in the last 12 months? (KG)
*
I want to...
*
Build muscle
Lose body fat
Get fitter
Get stronger
What would be your dream outcome at the end of the coaching process?
*
How long have you given yourself to reach your goal?
*
What's holding you back from achieving your goal?
*
What has motivated you to get in touch with me?
*
How important is your fitness goal to you? 1=not very 5=very
*
1
2
3
4
5
How motivated are you to exercise?
*
1
2
4
4
5
How experienced are you with weight lifting? 1=not very 5=very
*
1
2
4
4
5
Have you used MyFitnessPal before?
*
Yes
No
Details of any social events you have planned over the next 12 weeks
*
If you had to pick...
*
More cardio
Less food
Which describes your dieting style?
*
Hard and fast
Somewhere between the two
Slow and steady
The way you're eating currently are you...
*
Losing weight
Maintaining weight
Gaining weight
List meals that you like to eat regularly
*
List foods that you would eat on a 'bad day' and a 'good day' of eating
*
List any supplements you take
*
How mays times do you prefer to train per week?
*
3
4
More than 4
How many hours can you spend in the gym?
*
Name the gym that you train at
*
Are you willing to invest in £7.50 per day to reach your goal?
Yes
No
Thanks for filling our the form, click submit, then contact me to book your discovery call!
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