Pre Consultation for Jem's Empowered Movement

Jem’s Empowered Movement - Pre Consultation Form

This form will help me understand you and your goals so we can devise a plan together to reach them.
Name

First NameLast Name
Email
example@example.com
Phone Number
Occupation + usual working hours?
How did you come across my services (Jem’s Empowered Movement)?

Other
If other please let me know!
How important to you is it that you make these changes?

1

2

3

4

5

1 is , 5 is
Have you set yourself your own goals previously? If so what were they?
Did you achieve these goals
What did you try when pursuing these goals? (Tick all that apply)

Other
If you selected "Other" what was it?
What barriers did you face when trying to achieve these goals?

Other
If “other” what were they?
How would you rate your current activity level?
How would you rate your current nutrition habits? (1 = Terrible, 5 = Amazing)

1

2

3

4

5

1 is Worst, 5 is Best
Describe why you have put that number as your answer
What is your current gym experience? (Select all that apply)
When it comes to the gym, exercise and movement; what is it that you enjoy doing?
Is there anything specific you want to get better at in these areas? (E.G. I want to improve my squat technique)
And what do you dislike doing?
When it comes to achieving your goal, what do you feel like you need support with the most? (Select all that apply)
In your words, what are the main outcomes you would like to see from personal training/online coaching?
How long would you expect to be able to achieve that?
Time preference for PT sessions?
Is there anything else you feel would benefit my understanding of you and what you want to achieve?
Should be Empty:

Jem’s Empowered Movement - Pre Consultation Form