Application Form
Before we meet, I want to gain a deeper understanding of your specific goals and current challenges you are facing. This form serves as a crucial foundation to building a personalised plan tailored to your specific circumstances
Name
First Name
Last Name
Date
-
Month
-
Day
Year
Date
Email
example@example.com
Instagram Handle
How did you hear about me? What made you reach out?
Background Information
Current Bodyweight and Goal Bodyweight?
Primary Goal
Fat Loss
Muscle Gain
Image/Lifestyle Transformation
Learn how to Lift Correctly
Do you have a deadline to achieve your goals? What has stopped you from achieving them in the past?
What areas do you feel you need the most help with?
Please List any Health Conditions that may interfere with your training
Nutrition
Please rate your nutrition and food tracking on a weekly basis
Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
Provide a breakdown of your current nutritional habits
Do you currently Track your calories/macros?
Yes
No
Monday - Friday
Do you have any nutritional requirements?
Are you currently taking any supplements? Please explain
Training
Please rate your training at the moment (1 being worst it's ever been, 5 being best)
Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
Have you followed a training plan before?
Yes
No
What do you need help with most when it comes to your training?
Lifestyle Factors
Please rate your sleep quality
Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
Please rate your digestion
Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
Please rate your stress level
Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
Please rate your energy throughout the day
Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
Do you want to give additional details regarding your lifestyle?
I will be in contact within the next 24 hours to schedule a free phone consultation and discuss next steps to help you on your journey!
Health By Henry
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