Client Consultation Form

Client Consultation Form
Your Name*

First NameLast Name
Gender?*
Age?*
Your Height*
Your Weight*
Your readiness to change?*

12345678910
Past Medical History
Have you ever had (Please check all that apply)

AnemiaAsthmaArthiritisCancerDiabetesFainting SpellsHeart DiseaseHeart AttackHigh Blood PressureDigestive ProblemsKidney DiseaseLiver DiseaseSleep ApneaThyroid ProblemsOther
If you selected "other" please indicate below:
Are you currently taking any medication?*

YesNo
If "yes" please indicate below:
Current Lifestyle
How often do you exercise?*

Never1-2 Days3-5 Days5+ Days
What's your diet like?*

I have a loose dietI have a strict dietI don’t have a diet plan
Alcohol Consumption*

I don’t drink alcohol1-2 glasses a day3-4 glasses a day
Caffeine Consumption*

I don’t use caffiene1-2 cups a day2-3 cups a day3-4 cups a day
Are you currently taking any supplements?
If "yes" please indicate below:
Gym Location Preference
What is your preferred gym location?*

Your personal gym (Home/Condo gym)Personal training gym (Scarborough location)Online Training
Contact Information
Your Email*
example@example.com
Your Phone Number*
Please enter a valid phone number.
How did you hear about me?*

Word of mouthSocial MediaQR Code
Should be Empty:

Past Medical History