Form
Name
First Name
Last Name
Email
example@example.com
DOB and Age
Phone number:
Occupation + usual working hours
How were you made aware of my services?
Facebook
Instagram
Gym
Prior relationshiop
Referred by friend/family
What has attracted you to the use of me and my services as as a coach?
If referred please write their name below
How long have you been wanting to make a change to your lifestyle?
0-1 year
1-2 years
3-4 years
5+ years
How important to you is it that you make these changes?
Extremely important
Very important
Somewhat important
Not at all important
Have you set yourself your own goals previously? If so what were they?
Did you achieve these goals?
No
Some results
Yes
What did you try when pursuing these goals? (Tick all that apply)
Hired a coach - in person
Hired a coach - online
Followed a program
Gym classes
Made my own workouts
Diet clubs (slimming world etc)
Other
If 'Other' please specify here
When working towards these goals, what were the main barriers you had to overcome? (Select all that apply)
Lack of knowledge
Lack of understanding how to apply knowledge
Lack of time
Lack of motivation
Social/work life
Family commitments
Unsustainability of the approach you take (e.g. very extreme weight loss)
Other
If you selected "Other", please specify here
How would you rate your current activity level?
Sedentary (little to no activity, inactive job)
Light active (little daily activity, exercise 1-3 times per week)
Moderately active (Moderate amount of daily activity/walks/job, exercise 3-5 times per week)
Highly active (Active daily through walks/job, exercise 5-7 times per week)
How would you rate your current nutrition habits? (1 = Terrible, 5 = Amazing)
1 - Terrible all of the time
2 - Not great really more bad than good
3 - Not too bad decent through the week but go mad at the weekends
4 - I'm pretty good most of the time but don't see many results from that
5 - All over it, understand calories know what and how much to eat
Describe why you have put that number as your answer
What is your current gym experience? (Select all that apply)
Classes
Cardio
Resistance machines
Free weights (dumbbell, barbells)
Home workouts
Daily walks
Other
If you selected "Other", please specify here
When it comes to the gym, exercise and movement; what is it that you enjoy doing?
Is there anything specific you want to get better at in these areas? (E.G. I want to improve my squat technique)
And what do you dislike doing?
When it comes to achieving your goal, what do you feel like you need support with the most? (Select all that apply)*
Accountability - confirmation you are doing the right thing
Structure - knowing what to do and when
Consistency - support to overcome barriers that stop you continuing
Motivation - someone to support you through the process and get you going
Education - knowing why and when to apply the principles of health/fitness to your life
In your words, what are the main outcomes you would like to see from personal training/online coaching?
How long would you expect to be able to achieve that?
3 months
6 months
6-12 months
1-2 years
3+ years
Time preference for PT sessions?
Morning (9-12am)
Evening (5-7pm)
Online coaching only (no 1:1 sessions)
Is there anything else you feel would benefit my understanding of you and what you want to achieve?
Please book into a call with me to further get to know each other and see if I can fulfill your wants and goals moving forward.
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