1 on 1 Personalised Coaching Application
1 on 1 Coaching
Please note the coaching is for a minimum of 12 weeks
Full Name
First Name
Last Name
Gender
Male
Female
Age
years
Height
cm
Weight
KG
Whats the activity level at your job?
None (seated only)
Moderate (light activity such as walking)
High (heavy labor, very active)
Please list the physical activities that you participate in outside of the gym and outside of work:
If you have any diagnosed health problems list the condition(s).
If you have any injuries, please list them.
Are you a current cigarette smoker?
Yes
No
Your current diet could be best characterized as:
No red meat
Vegetarian/Vegan
No special diet
Other
Please rate your readiness for change.
1
2
3
4
5
6
7
8
9
10
What following goals does best fit in with your goals?
Improved health
Improved endurance
Increased strength
Increased muscle mass
Fat loss
Please tell me in depth what you would like to achieve
TImeline for achieving your goal.
Rows
8 WKS
12 WKS
24 WKS
32 WKS
40 WKS
1 YEAR
NOW
How often are you willing to train a week to reach your goal?
Are you currently excersising regulary (at least 3x per week)?
Yes
No
Have you trained with a personal trainer before?
Yes
No
What are your expectations on me as your Personal Trainer?
PT Package option
Personalised Coaching: $75.00 a week for a minimum of 12 weeks
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Instagram handle: (for if I can’t reach your phone number)
Email
*
example@example.com
Submit
Should be Empty: