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Personal Training - Lidia Fraser
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Gender
Female
Male
Height
cm
Weight
kg
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Do you have any diagnosed health problems?
Are you taking any medications? If yes, please list below.
Do you have any current/past injuries & pain? If yes, please list below.
Do you have any of the following: Diabetes, blood pressure over 140/90, asthmatic, family history of heart disease or stroke if yes, please elaborate:
What do you do for work? *
How active is your job? (sitting, standing, walking, physical labor, etc.)
Do you smoke? If so, what do you smoke? And how often?
Do you drink? If so, what do you drink? And how often?
What is your daily stress level?
Low
1
2
3
4
High
5
1 is Low, 5 is High
What is your daily activity level?
None
1
2
3
4
High
5
1 is None, 5 is High
How many days a week do you currently workout? Please also explain what exercise(s):
Back
Next
How does your current diet look like?
Low-fat
Low-carb
High-protein
Vegetarian/Vegan
No special diet
Please walk me through a typical day of eating. Including ALL drinks, meals, snacks, supplements and at what times you eat all these things. Be as honest as possible. *
How many times do you eat out a week? Please provide your go-to places / what you'd order:
What is your #1 fitness goal right now? *
What are you other goals?
Which of the following statements fit in with your goals?
Improved health
Improved endurance
Increased strength
Increased muscle mass
Fat loss
De-stress
Other
What are you currently doing to work on this goal? *
What is your #1 struggle right now and how is it holding you back from your goal? *
What are your short term goals? (1-2 months) *
What are your long term goals? (4-12 months) *
Why do you want to start now? Why do you want to make these changes in your health and fitness NOW? *
Please rate your readiness to change.
Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
How committed are you to reaching your goals and making a transformation? *
What are your expectations working together?
I am going to teach you how to achieve your goals in a way you can sustain them for LIFE without dreading the process to get there. Are you willing to invest your TIME and ENERGY into this program, and trust me to deliver the results you want? *
My coaching program is not a cheap *cookie-cutter* program. It's hands on 1-to-1 coaching tailored to your SPECIFIC goals and NEEDS. Why do you think you'll benefit from coaching? *
Did a friend refer you to me? If so, who? *
Anything else you think will be relevant...
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