Initial Consultation Form
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Age, Weight & Height?
*
What are you hoping to achieve short term? (8-12 weeks)
*
Is there any performance goals you would like to work towards? (eg. Squat/Deadlift, Running, Pull-ups etc)
On a scale of 1-10, how important is it that you achieve these goals?
Not very
1
2
3
4
5
6
7
8
9
Extremely
10
1 is Not very, 10 is Extremely
What are you hoping to achieve long term? (6-12 months)
Mindset work is an important component of all Health and Fitness journeys. Is there any particular mindset improvements you would like to work towards?
What do you feel you struggle with when working towards your goals?
Are you currently/have you followed any training/nutrition protocols? If yes, please explain in as much detail as possible!
What is your occupation and what would you rate your daily activity level as? (Sedentary, lightly active, active, very active)
*
Have you worked with a PT/Online Coach before? If yes, please provide detail in terms of training, nutrition, results, any things you liked/didn't like
What is your relationship with food like?
How many days per week can you commit to training and roughly how long for each session?
Health Questionnaire
What is your average sleep (hours) per night?
*
How many litres of water do you drink per day?
*
Do you smoke/drink? If yes how many/often?
Do you have any health issues that I may need to know about?
Any food allergies/intolerances or dislikes?
Please upload 3 current full body photo's (side, front, back)
*
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When would you like to start with me?
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Month
-
Day
Year
Date
What type of coaching are you after?
Nutrition Only
Training Program Only
Nutrition & Training Program
Thank you for completing the form!
Please click submit and I will be in touch via email with further info on pricing and different packages I have available
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