Consultation From
Welcome! I’m Sumiya-Troi your fitness coach.I am a certified personal trainer and nutritionist dedicated to helping you transform through fitness, healthier habits, & an elevated mindset . My goal is to guide you with customized fitness and nutrition strategies that fit your lifestyle, while keeping you motivated and accountable along the way.This consultation form is designed to help me get to know you better—your goals, health history, and preferences—so I can create a program tailored specifically to you. Please answer each question as honestly as possible. Your information will remain confidential and will only be used to support your journey.
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Tell me about your fitness goals (weight loss, muscle gain, strength, energy, confidence, etc.)
Why is that goal important to you?
How many days per week can commit to working out?
What usually gets in your way when you try to stick with a routine?
What areas of your body do you want to focus on the most?
What are you looking for in a trainer? How can I best support you and help you reach your goals?
Do you have experience lifting weights?
Tell me about your nutrition goals…any food allergies, preferences, or restrictions I should know about?
What are you eating habits like?
What’s been your biggest obstacle when it comes to your eating habits?
Where do you struggle the most
Workouts
Nutrition
Consistency
Motivation
Do you feel rested when your wake up
Yes
No, always tired
I have a inconsistent sleep schedule
Are you taking any medications that may affect exercise? If so please disclose
Do you have any current or past injuries?
Yes
No
If you have any current or past injuries please disclose them here
Do you have any health/medical conditions I should know about? If so please disclose
What is your current weight?
What is your goal weight?
What’s your age?
What is your height?
Back
Next
Do you currently have a gym membership? If so where?
How many hours of sleep do you get at night?
4hrs or less
5-6
6-7
7-8
9+
What level of accountability do you need
Check ins 1 day a week
Check ins 2 days a week
Check ins 3 days a week
Check ins 4 days a week
Check ins 5 days a week
What’s your budget for personal training?
On a scale from 1-10 how confident are you that you can achieve your goals?
1
2
3
4
5
6
7
8
9
10
Submit
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