RESULT PROGRESSION PARQ

1
Name* This field is required.
First Name
Last Name
2
Email* This field is required.
example@example.com
3
Phone Number* This field is required.
Country Code
Area Code
Phone Number
4
Preferred way for your coach to contact you* This field is required.
WhatsApp
Text
Phone call
Email
5
What results do you wish to achieve?* This field is required.
Reduce Body Fat
Weight loss
Reshaping
Strength Training
Sports conditioning
Increase fitness
Improve muscle tone
Improve flexibility
Tone
Other
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Why would you like to achieve these results?* This field is required.
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When would you like to achieve these results?* This field is required.
8
How long have you been thinking about these results?* This field is required.
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What has kept you starting sooner?* This field is required.
10
Where do you want to achieve these results?* This field is required.
Thighs
Glutes
Hips
Arms
Back
Lower back
Stomach
Waist
Shoulders
Other
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What will change when you achieve these results?* This field is required.
Huge
Large
Normal
Small
Ok
Ok
12
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
13
If other please explain?
14
Occupation / job role* This field is required.
15
If your performance could improve by 10% in one area next month, which would you choose?* This field is required.
Muscular Strength
Recovery
Body Composition
Muscular Endurance
Flexibility
Cardiovascular Endurance
16
What best describes your usual workday?* This field is required.
Mostly seated/desk-based
Mixed sitting and moving
Mostly on feet
Physically demanding/manual
Shift work/variable
Other
Other
17
If other please explain?
18
What are your usual working hours or shift pattern?* This field is required.
19
Does work, commuting, caring responsibilities or anything else regularly affect when you can train, sleep or recover?* This field is required.
20
What does your current weekly exercise or physical-activity routine look like?* This field is required.
21
How would you describe your previous training experience?* This field is required.
Beginner
Some experience
Experienced
Returning after a break
Other
Other
22
What equipment or training facilities do you normally have access to?* This field is required.
23
How many days per week do you wish to exercise?* This field is required.
1
2
3
4
5+
24
What exercise do enjoy the most?* This field is required.
Strength Training
HIIT
Boxing
Circuit Training
Running
Rowing
Other
25
If other please explain?
26
How have your energy levels been over the last month?* This field is required.
Consistently high and steady
Up and down depending on stress or sleep
Lower than usual but improving
Very low - I need help rebuilding energy
27
On average how well have you been sleeping?* This field is required.
Deep, restful sleep most nights
Fair but interrupted
Light or restless
Poor - I’d like to improve this
28
On Scale of 1-10, What’s your current stress level most days (1 low - 10 high)* This field is required.
1
2
3
4
5
6
7
8
9
10
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What tends to cause you the most stress at the moment?* This field is required.
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When do you feel your best during the day?* This field is required.
Morning
Midday
Evening
31
What is one small daily habit that would help you feel more balanced or recovered this month?* This field is required.
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How would you describe your typical daily diet?* This field is required.
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On a scale of 1-10, how confident are you in your nutritional knowledge? (1 low - 10 high)* This field is required.
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2
3
4
5
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7
8
9
10
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How consistent have you been with your nutrition plan or guidance?* This field is required.
Every day without fail
Most days but some off-track
Hit and miss
Need a full reset
Other
35
What is your biggest challenge when it comes to maintaining a balanced diet?* This field is required.
36
What’s worked best for you when your nutrition has been most consistent?* This field is required.
37
Are there any specific foods or nutritional habits you’d like to adjust?* This field is required.
38
How has your motivation felt recently?* This field is required.
Strong and clear
Focused but fluctuating
Needing a spark
Struggling to stay on track
39
How much do you believe in your ability to achieve your goal? ( Scale 1-10)* This field is required.
1
2
3
4
5
6
7
8
9
10
40
If other please explain?* This field is required.
41
How confident do you feel about staying consistent this month? ( Scale 1-10)* This field is required.
1
2
3
4
5
6
7
8
9
10
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When things feel difficult, what usually helps you get back on track?* This field is required.
43
When you’ve achieved big wins in the past, what mindset or behaviour helped you the most and how can we bring that back now?* This field is required.
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What’s one shift in mindset, routine, or environment that would make everything easier?* This field is required.
45
Have you ever experienced any of the following?* This field is required.
Heart trouble
Dizziness or fainting
Joint problems
Asthma
Sports injury
Arthritis
Other
46
If other please explain?* This field is required.
47
List any current injuries, medications, or health conditions your coach should be aware of.* This field is required.
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Ok
48
Have you had any recent check-ups, bloodwork, or health screenings worth noting?* This field is required.
49
Do you smoke?* This field is required.
Yes
No
50
Are you pregnant?* This field is required.
Yes
No
Other
51
Emergency contact full name* This field is required.
First Name
Last Name
52
Emergency contact relationship to you* This field is required.
53
Emergency contact phone number* This field is required.
Country Code
Area Code
Phone Number
54
How best can your coach support you this month?* This field is required.
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Large
Normal
Small
Ok
Ok
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Do you feel you’re getting the right balance between push and support?* This field is required.
Perfect balance
Need more push
Need more support
Not sure yet - still finding rhythm
56
Is there anything you’d like added or adjusted in your program or check-ins to help you feel even more supported?* This field is required.
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57
When you think about the next 4 weeks, what excites you most about the progress you could make?* This field is required.
58
When you picture yourself in 90 days from now, how would describe them in 3 words?* This field is required.
59
If it’s not a 10, what’s missing to make it one?* This field is required.
60
What do you think your coach will notice first when you’ve hit that next level version of yourself?* This field is required.
61
If you could message your future self from today, what advice would you them to stay consistent?* This field is required.
62
On a scale from 1 to 10, how ready do you feel to take full action towards your goals? (1 low to 10 high)* This field is required.
1
2
3
4
5
6
7
8
9
10
63
Why is it so important for you to achieve these results?* This field is required.
64
If it’s not a 10, what’s missing to make it one?* This field is required.
65
Name
First Name
Last Name
66
Any other information, documents or files that you wish to share that can help assist in your progression?
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
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67
Date of Birth (D.O.B)* This field is required.
Date
Month
Day
Year
68
Gender* This field is required.
Male
Female
Other
69
Signature* This field is required.Consent & Acknowledgement: By signing, I confirm that all information provided is accurate to the best of my knowledge and consent to participate under Result Fitness guidance.
70
Would you like to book your consultation now?* This field is required.
Yes — book my consultation now
I’ll arrange it directly with RESULT Fitness
71
Next step: Book Consultation https://book.stripe.com/7sY9AVake8wW6oA28c7IY1r
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