New Client Application & Consultation
Please complete this form, so I can best help you. I will aim to contact you within 48hrs of submission with the next steps.
Date
-
Month
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Day
Year
Date
Name
First Name
Last Name
Email
example@example.com
Phone Number
-
Area Code
Phone Number
Height (cm's)
Weight (kg's)
Age (years)
What are you post Long COVID training goals?
Weightloss
Muscle gain
Strength gain
Athletic performance
Injury Prevention
Flexibility or mobility
Cardiovascular endurance
Self-esteem or confidence
Training consistency
Other
Do you have any specific goals e.g. return to competitive sport, or a running event?
What is your sport and training background?
Prior to Long COVID, how often were you training and what were you doing?
Has your mindset to training changed because of Long COVID? If yes, please explain.
What emotional, physical or situational barriers do you require help with?
What if any movement or exercise are you currently doing? And how has your body responded?
Are you confident that you are ready for a progressive exercise program? If yes, please explain why. If no, please provide more information.
Compared to now, how do you want to feel and what do you want to be able to do, by the end of your 12 week rebound program?
Finishing this statement below...
I have the financial resources to invest in my rebound training journey if the right opportunity was before me.
I have access to the financial resources to invest in my rebound training journey if the right opportunity was before me.
I don't have the financial resources and don't know where I would get them to invest in my rebound training journey.
Finish this statement too. If someone advised me to invest £500-£700 in my health and fitness, I would...
Know it's a big part of getting back to my athletic self and I would do it, if I had the right accountability, support and system to follow.
Be a little intimated but with the right proven system, I would do it as I want to invest in getting back.
Avoid it, as I am looking for a cheaper way to get my fitness and identity back.
What equipment do you have access to?
Dumbbells
Kettlebells
Barbell
Mini Bands
TRX
Loop Resistant Bands
Machine weights
On which days do you plan to workout?
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Submit
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