Client Consultation Enquiry
let me get to know you!
Name
First Name
Last Name
Email
example@example.com
Phone Number
-
Area Code
Phone Number
Date of Birth
-
Month
-
Day
Year
Date
Have you used a PT before?
Yes
No
How often do you currently do physical activity
No
1-2 days a week
2-3 days a week
3-4 days a week
5+ days a week
List any past or current types of activity (eg: gym workouts, outdoor cardio, sports clubs)
Please state any medical conditions/injuries (eg asthma, CVD, arthritis)
What is your occupation
Full time work
Part time work
Student
Unemployed
Other
Back
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Within your line of work how much activity do you do?
No activity (seated office work)
Moderate (light activity throughout the day, eg walking)
High (high levels of walking, lifting or movement throughout the day)
Vigorous (very high levels of activity such as lifting, on the move all day)
What time suits your availability
AM
PM
During the day
It varies
Available any time
Where will you be training
Commercial gym (eg puregym)
Leisure centre
Home with gym equipment
Home with NO gym equipment
Other
What is your goal
When do you want to achieve this goal for?
8-12 weeks
12-16
16-20
24+ weeks
How many days a week do you want to invest in yourself?
1 day/week
2 days/week
3 days/week
4-5 days/week
What is your preference by way of contact
Phone calls
Messages
Email
Social Media
Submit
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