Coaching Interest Form

Please complete the form below to register your interest for coaching with me.

Thank you so much! I'll be in contact in the next 2-5 working days! Gee x
Name

First NameLast Name
Birth Date

MonthDayYear
Gender

FemaleMale
Height
cm
Weight
kg
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Are you looking for Online coaching or In-Person coaching?

OnlineIn-Person
Do you have any diagnosed health problems?
Are you taking any medications? If yes, please list below.
Do you have any injuries? If yes, please list below.
How does your current diet look like?

Low-fatLow-carbHigh-proteinVegetarian/VeganNo special diet
Do you smoke?

YesNo
What is your daily activity level?

1

2

3

4

5

1 is None, 5 is High
What is your daily stress level?

1

2

3

4

5

1 is Low, 5 is High
What days are you wanting to train?

MondaysTuesdaysWednesdaysThursdaysFridaysSaturdaysSundays
What times are available to train?

Early morning1pm - 5pm9am - 1pmAfter 5pm
What are you looking to gain from having a personal trainer?
Which of the following statements fit in with your goals?

Improved healthImproved enduranceIncreased strengthIncreased muscle massFat lossOther
What are your biggest challenges for health and fitness?
Please rate your readiness to start and change.

1

2

3

4

5

1 is Worst, 5 is Best
Should be Empty:

Please complete the form below to register your interest for coaching with me.