Training Enquiry Form

Daily energy levels*

	1	2	3	4	5

1 is Always Tired, 5 is Always wired

Readiness to make changes to your diet and nutrition*

	1	2	3	4	5

1 is I am not ready yet, 5 is I am ready to change!

Daily Stress Levels*

	1	2	3	4	5

1 is Always Tired, 5 is Always wired

Motivation to be fit and healthy*

	1	2	3	4	5

1 is I am struggling, 5 is I am ready to go!

Readiness to make changes to your current lifestyle and activity levels*

	1	2	3	4	5

1 is I am not ready yet, 5 is I am ready to change!

By signing below you agree to all of the subject matter stated herein and above. You confirm that you are of at least 18 years of age and have the right to agree to all of the above and that all of the information you have given is correct to the best of your knowledge.

Signature

	6am-9am	9am-12pm	12pm-3pm	3pm-6pm	6pm-9pm	9pm-12am	Not available
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Program enquiry

1. Personal Information

2. Lifestyle Information

3. Your Goals

4. Diet & Nutrition

5. Training Sessions

6. Readiness to change

7. Confirmation