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One Life Fit-Check
Before we get started, we want to understand who you are, not just what you want to achieve. This form helps us figure out the best way to support you. There are no right or wrong answers, just be honest.
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5
Date of Birth
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6
Emergency Contact Information
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Full Name
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Latvia
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Libya
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Lithuania
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Mali
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Mongolia
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Portugal
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Samoa
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Senegal
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Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
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Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
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7
Where did you hear about us?
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Instagram
Facebook
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Friend/Family
Recommended by someone else
Physician Referral
Event
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Instagram
Facebook
Google
Friend/Family
Recommended by someone else
Physician Referral
Event
Other
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8
How would you rate your overall fitness level?
This includes all areas of fitness - cardio, strength, mobility etc.
1
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9
What is your relationship with the gym?
Never been inside a gym before
Been a few times but never consistent
Regular gym user
The gym is my life
I used to be consistent but have fallen off
I''m either "off" or "on. I go too hard too soon and quit
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10
What motivated you to get started with us?
I'm fed up of not taking action
I want to try something new
You've been highly recommended
I need a push into action
I don't know how to do this alone
I want to reach the next level
I need a plan to follow
I need accountability
Other
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11
Have you ever worked with a Personal Trainer?
In Person or Online
YES
NO
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12
If so, why did you end up quitting?
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13
What do you want to get out of your journey with us straight away? (Within 2 months)
What excites you right NOW? How can we get you off to the best possible start?
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14
What do you want to get out of your journey with us in the long-term? (6 months+)
This should line up with your values and life vision - Do you want to win competitions? Do you want to set a good example for your family? What do YOU want?
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How important are these goals to you?
This should line up with your values. Be honest with us!
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2
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5
Not that important
It needs to happen
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What are the reason/s you haven't achieved this goal on your own?
What have you struggled with? Time? Money? Accountability? What do feel has held you back?
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17
Is this reason/issue resolved or being resolved?
We presume so, seeing as you are taking action today!
YES
NO
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18
How good would you say your diet is?
Nutrition is one of the cornerstones of health...
1
2
3
4
5
Very poor
Amazing
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19
Do you think your nutrition requires change in order for you to achieve your goal?
YES
NO
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20
How stressful is your job/lifestyle?
1
2
3
4
5
I am chilled to the max!
I am stressed to the max
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21
What do you do for work?
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22
Please list any pre-existing and/or current medical conditions
Do your best to be specific and detailed - we want to keep you safe!
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23
Please list any past or present pains and injuries
Do your best to be specific and detailed - we want to keep you safe!
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24
In relation to these Injuries and Medical Conditions, are you seeing/have you seen the appropriate medical professional?
If so, please leave their contact details below.
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25
Do you have a Medical Clearance to engage in Physical Exercise from this professional?
If so, we'll need a copy.
YES
NO
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26
Blood Pressure
+ When was the last time you had this checked?
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27
You're about to make a commitment to improve yourself and it's our job to help you. What do you expect of us?
Do you need accountability? Do you want a detailed plan written for you? Do you want us to educate you along the way? Feel free to give us multiple answers.
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28
Which coaching format would best suit you?
In- Person Training (One Life Yangebup)
Online Training
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29
How much do you expect to invest into coaching? (weekly)
$50-100
$100-200
$200-300
I don't care I just want results
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