Adam Ballinger Fitness Screening Form

1

What is your full name?* This field is required.

2

How old are you?* This field is required.

3

What is your instagram @?* This field is required.

4

What is your phone number?* This field is required.

Area Code

Phone Number

5

What is your email address?* This field is required.

6

Are you in a position financially to invest and get started now?* This field is required.

YESNO

7

Which of these options best describes you right now:* This field is required.

I'm new to this and unsure where to start

I have started but now I'm struggling to see progress

I am mainly looking for structure, accountability and guidance

I know what to do, but I need the drive that having a coach will provide

Other

8

What is the main goal that you want to achieve right now?* This field is required.

To lose fat and drop excess weight

To build lean muscle

To get into good eating habits and regular training

To get shredded for a holiday or event (or in general)

To compete on stage

Other

9

Why do you think you have not yet achieved your goals?* This field is required.

Lack of knowledge

Lack of time

Lack of accountability

Lack of commitment

Other

10

What would you say you would most like to achieve within the next year?* This field is required.

To be the healthiest and happiest version of yourself

To put on a significant amount of lean muscle

To get into a good position to be able to start a prep

To get in shape and do a photoshoot

Other

11

Are you aware that my coaching services are premium programmes specific for each client? Ie. They aren't 'cookie cutter' or budget programmes * This field is required.

YESNO

12

If there was an opportunity to work with me privately for a prolonged period of time, how much would you be willing to invest?* This field is required.

Nothing, I'm currently skint

Less than £500

More than £500

Whatever it takes!

13

Do you have a specific time frame that you want to achieve your goals by and if so, when do you want to start working towards them?* This field is required.

14

What is it about Adam Ballinger Fitness that makes you interested to know more and potentially work with me?