Client Consultation Form
Please provide as much information as you can.
Name
First Name
Last Name
Email
example@example.com
Phone Number
-
Area Code
Phone Number
HEALTH & MEDICAL HISTORY -
Current weight
kg
Height
cm
Age
years
What is your metabolism/digestion like? (Pain, bloating, stools etc. Discuss any symptoms of flaring if suffering from chronic or autoimmune disease.)
Do you have any existing medical conditions? (e.g: diabetes, asthma, heart disease)
Have you had any surgeries or injuries? If yes, please describe.
Are you currently taking any medications? If yes, please list.
Have you been advised by a doctor to avoid physical activity? If yes, please explain.
LIFESTYLE & HABITS -
Occupation
Typical daily schedule (work hours, family obligations etc)
How many hours of sleep do you get per night?
Rate your daily stress levels between 1-10
Do you currently follow any specific diet or nutrition approach?
Do you smoke and/or consume alcohol?
EXERCISE & ACTIVITY HISTORY -
Are you currently exercising? If yes, what type/how often?
Have you worked with a trainer or coach before?
What kind of physical activity do you enjoy or dislike?
Are there any movements or exercises you are unable to perform?
GOALS & MOTIVATION -
What is your primary fitness goal? (e.g: fat loss, muscle gain, performance)
What are secondary goals (if any)?
Why are these important to you?
What timeline do you envision to reach your goals?
How committed are you to your goal?
NUTRITION & EATING HABITS -
How many meals/snacks do you eat per day?
Do you track your food intake? If yes, how? (app, journal)
Do you prefer meal plan or flexible dieting?
Do you have any allergies, dietary restrictions or food intolerances?
Describe a typical day of eating:
Do you take any supplements?
READINESS & COACHING EXPECTATIONS -
How many days per week can you commit to training?
Have you tried to reach your goals in the past? What worked/didn't?
Do you prefer home workouts or gym?
Do you have any questions for me?
CONSENT & AGREEMENT -
Data Protection and Privacy Consent
I understand that the information I provide on this consultation form is confidential and will be used by Grow with Gina to ensure safe and appropriate service delivery. My data will be stored securely and will not be shared with third parties without my consent, unless required by law. I consent to the collection, processing and storage of my personal and sensitive information in accordance with applicable data protection laws. I understand that I may request access to or deletion of my data at any time.
Agree
Signature
Date
-
Day
-
Month
Year
Date
Thank you for completing the consultation form. Coach Gina will be in contact with you to organise a call
Continue
Continue
Should be Empty: