DECFORD HUTCHINS
PERSONAL TRAINER
PURE GYM CANARY WHARF
5 Hertsmere Road, London E14 4AN
decfordpt@yahoo.co.uk
www.decfordpt.com
ENQUIRY FORM:
Full Name
*
First Name
Last Name
E-mail
*
example@example.com
Phone Number
*
Format: (00000) 000-000.
Are you already a member at Pure Gym CANARY WHARF? (Answering yes or no does not affect you being entitled to your consultation)
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Yes
No
What is your age?
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18-24
25-34
35-44
45-54
55-64
75+
What is your main fitness goal? (Multiple Choice)
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Fat Loss
Build Muscle
Get Stronger
General Fitness
Eat Better
Other
how would you describe your training experience?
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Beginner
Intermediate
Advanced
When are you generally available for your for training?
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Early Mornings (6am-9am)
Late Mornings (9am-12pm)
Midday (12pm-2pm)
Late Afternoon (2pm-5pm)
Evenings (5pm -9pm)
Weekends
What days suit you best?
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Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
If any, what is the biggest hurdle for you not achieving your goals? You can check more than one answer
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Not enough time
Gym knowledge / lack of guidance
Too many social events
Understanding Nutrition
Other
What best describes your current training?
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I have no confidence in a gym environment and do not know what I'm doing
I have a little confidence, but stick to what is right for me
Fairly confident, I like to try things I've seen in videos and social media
I'm confident in a wide range of exercises but would like to gain more understanding and knowledge
I'm confident in all aspects of my training
Other
What best describes your nutrition?
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I have no idea what or when to eat
I have a good idea of what to eat but struggle to stick to it
I track my food sometimes but not consistently
Eat well but struggle on weekends or/and social events
I track my food, follow a plan and have no issues with nutrition
Would you benefit with guidance with nutrition?
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Yes
No
Maybe
Are you ready to investing personal Training if it's a good fit?
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Yes ready to start
Maybe need more info
Just Exploring
Can you train at Pure Gym Canary Wharf?
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Yes
No
Why is now the time you want to change?
Is there anything else you would like me to know
Tell me a bit about yourself. What would be your absolute dream goal to achieve via personal training and why? (optional)
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