Online Coaching Consultation Form

1

Name* This field is required.

First Name

Last Name

2

Phone Number* This field is required.

Area Code

Phone Number

3

Email* This field is required.

example@example.com

4

DOB* This field is required.

5

Height (in cm)* This field is required.

(e.g. 178cm)

6

Weight (in kg)* This field is required.

(e.g. 75kg)

7

Any current or previous injuries/mobility impairments I should know about?* This field is required.

Yes

No

8

If you selected “Yes”, please state here:

9

How familiar are you with the gym floor* This field is required.

Newbie, definitely need a helping hand.

I’m somewhat familiar but need guidance / just came back to the gym after a long time off

I’m very experienced on the gym floor, I just love a challenge!

10

How active are you?* This field is required.

Sedentary lifestyle (Little to no exercise)

Lightly active (1-2 times a week)

Moderately active (3-4 times a week)

Very active (5+ times a week)

11

What are your fitness goals* This field is required.(Answer with specific goals and a timeframe, e.g. lose 5kg body fat in 3 months)

12

Exercise likes and dislikes(Eg, I like performing squats and bench presses, I dislike using the treadmill)

13

Average sleep pattern* This field is required.

7-8hrs

5-6hrs

I struggle to get good sleep in most days

Other

14

Talk me through your nutrition(What kind of diet do you follow, how much protein do you consume, how much hydration do you get a day)

15

Talk me through how your week looks typicallyHow many hours a week do you spend working/studying, any hobbies or other commitments you have?

16

What is your biggest barrier holding you back from achieving your goals?* This field is required.(eg, I keep putting off exercise and promising myself to do it next week or in the new year / I’m unable to find the time due to work and other commitments)

17

Are you ready to smash your fitness goals?* This field is required.

Yes, dead serious!

No, perhaps later.

18

Are you in a position to invest yourself financially towards your fitness journey?* This field is required.

Yes, health is wealth!

I’m unable to do so at the moment.

19

When would you like to start your fitness journey * This field is required.

(eg, ASAP, tomorrow, next week or a specific date)

20

Signature* This field is required.