Online Health Questionnaire
Please complete the online health questionnaire and book in with me below
Full Name
First Name
Last Name
Email
example@example.com
Gender
Male
Female
Other
Date of Birth
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
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Day
Please select a year
2026
2025
2024
2023
2022
2021
2020
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Year
Age
years
Height
cm
Weight
KG
What do you do for a living?
Tell me about your fitness goals. What would you like me to help you with?
Increase Muscle Mass
Lean Muscle Tone
Strength
Power
Agility
Health & Wellbeing
Mobility & Flexibility
Recovery
Functional Training
More Energy
And could you provide me with a little more detail about your fitness goals and what's the priority?
Are you training for anything specific like an event, holiday, wedding? And do we have a time frame?
What methods of training/exercises do you like?
Anything you hate and why? It can be exercises/classes/type of training concept/you didn't see results from them/boring. Be as specific as you can.
Could you give me a breakdown of your weekly training. If you could include specific exercises/rest, reps and sets would be great.
How long have you been training like this/doing this program for?
Do you have any existing injuries or are prone to any?
Yes
No
If yes, could you specify what injuries they are
Do you experience issues after exercise, ie left hip and always hurts days after a run?
Any physical health concerns?
Yes
No
Please specify if answered yes
Do you take any regular medication?
Yes
No
Please list if answered yes
Do you drink alcohol?
Yes
No
Do you smoke cigarettes and/or vape ?
Smoke
Vape
Both
No
Do you take any recreational drugs including performance enhancing drugs?
Yes
No
Do you have any mental health conditions?
Yes
No
If answered yes to any of the above and you feel comfortable, please feel free to share anything below
Do you currently follow any specific diet?
Yes
No
What are your eating habits like? Highlight as many as you like
Prepped & cooked fresh myself
Binge
Skip meals
Regimented
Use a food company
Eat on the go
Eat late
Great on weekends/weekend ruined
Pick/graze/snacking
Clean
Which diet are you currently on?
Are you currently taking any supplements/wish to try and know more about?
Things you struggle with the most when it comes to nutrition. Highlight as many as you'd like and which ones effect you most.
What to eat and when
How much I should eat
Discipline/staying consistent
Sugar addictions
Emotional eating
Boredom
Satiety levels (always hungry/struggling for appetite)
What supplements to take and when
Frequent takeaways
Hydration
How's your sleep on average? Highlight as many as you like.
Less than 5 hours
Disturbed
5-6 hours
I take sleeping tablets
6-7 hours
I use supplements like magnesium
More than 7 hours
Sporadic
Hydration
I find it difficult to switch off
Do you meditate?
Yes
No
Sometimes
Never tried
Not interested
Other
Have you had an online personal trainer before?
Yes
No
How would you like us to communicate when working together?
Messanger only
daily communication
Once a week catch up
Book in with me for your consultation:
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