Online Coaching Enquiry Form
1. Personal Information
Name
*
First Name
Last Name
Email
*
example@example.com
Contact number
*
-
Country Code
Phone Number
Instagram handle
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2. Health/Medical Information
Do you have any diagnosed health/medical conditions that I should be made aware of?
*
Yes
No
If you do, please list them here. Be as detailed as you can about, what it is, how it affects you and how you are managing your symptoms
*
Type 'not applicable' if you answered 'No' to the previous question
Have you had any injuries recently or in the past that I should be made aware of?
*
Yes
No
Do you smoke or vape?
*
Yes
No
Occasionally
Other
How many hours of sleep do you get on average per night?
*
4 hours or less
5-7 hours
8+ hours
I don't know
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3. Your Goals
What is your main goal and why is this goal important to you?
Where would you like to see yourself in the next 6 months?
Realistically when do you want to achieve your goals?
*
Rows
8 WEEKS
12 WEEKS
16 WEEKS
24 WEEKS
32 WEEKS
40 WEEKS
1 YEAR
1+ YEARS
START
What has stopped you in the past from achieving these goals?
*
Give as much detail as possible
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5. Diet & Nutrition
Have you tracked calories before?
*
Yes - MyFitnessPal
Yes - another app
No
How often do you eat fast food/takeaways? Be honest.
*
less than once a month
twice a month
once a week
more than once a week
every day
never
Do you want any help from me with nutrition?
*
Yes - weight management
Yes - Muscle growth
Yes - making better food choices
No thanks
What specifically would you like support with?
*
Give as much detail as possible. If you answered 'No' then type 'Not Applicable'
Do you have any dietary restrictions?
*
List any allergies, intolerances, medical conditions causing restrictions
Is there anything else that could affect your ability to adhere to a diet that you need to consider?
*
i.e. social events, family events, holidays, religious obligations etc.
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6. Training Sessions
How many times a week do you train/workout?
*
Zero
1-3 days per week
3-5 days per week
6-7 days per week
How long have you been training?
*
less than 6 months
6 months - 1 year
1-2 years
2+ years
Other
What kind of training do you do?
*
Weight training in the gym
Gym classes
Home/Outdoor workouts
Personal Training sessions
Other
What kind equipment do you have access to use in your in your programme?
*
Full gym
Fixed resistance machines
Cable machines
Functional equipment
Barbells
Dumbells
Squat rack
Other
Is there anything else that could affect your aility to participate in sessions that you need to consider?
*
i.e. holidays, religious obligations, childcare etc.
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7. Readiness to change
Please rate each category on a scale of 1-5
Daily energy levels
*
1
2
3
4
5
Always Tired
Always wired
1 is Always Tired, 5 is Always wired
Readiness to make changes to your diet and nutrition
*
1
2
3
4
5
I'm not ready yet
I'm ready to change!
1 is I'm not ready yet, 5 is I'm ready to change!
Daily Stress Levels
*
1
2
3
4
5
Always Tired
Always wired
1 is Always Tired, 5 is Always wired
Motivation to be fit and healthy
*
1
2
3
4
5
I'm struggling
I'm ready to go!
1 is I'm struggling, 5 is I'm ready to go!
Readiness to make changes to your current lifestyle and activity levels
*
1
2
3
4
5
I'm not ready yet
I'm ready to change!
1 is I'm not ready yet, 5 is I'm ready to change!
Are you willing to invest in yourself for a minimum of 16 weeks? (This time frame ensures you achieve the best results).
YES
Any questions for me?
Submit
Should be Empty: