Name
*
First Name
Last Name
Age
Email
*
example@example.com
Instagram Username
What are your specific goals?
How important is it for you to make these changes?
Not Important
1
2
3
4
5
6
7
8
9
Very Important
10
1 is Not Important, 10 is Very Important
Why are these changes important to you?
When working towards your goals what were the main barriers you had to try to overcome?
Time?
Knowledge?
How to apply the knowledge?
Motivation?
Unsustainable process?
Social life / work lifestyle?
Family?
Other?
How would you rate your current activity levels?
Sedentary – Little to no daily walks, desk job little to no exercise
Lightly active – Lightly active plus exercise 1-3 times per week
Moderately active – Moderate daily walks/activity plus exercise 3-5 times per week
Very Active – Highly active with walks/daily activity and exercise 5-7 times per week
How would you rate/describe your current nutrition?
1. Terrible all of the time
2. Not great really more bad than good
3. Not too bad decent through the week but over on weekends
4. I’m pretty good most of the time but don’t see many results from that
5. All over it, understand calories know what and how much to eat
Some detail on why you've chosen that number?
What is your experience with weight training or gym?
When it comes to trying to achieve your goal, what do you feel like you need support with most?
Accountability - Constant confirmation you're doing the right thing
Structure - What to do and when to do it
Education - Knowing why and how to apply the principles into your life
Motivation - Have someone to support you through the process
Staying consistent - Support to overcome barriers
In your words, What are the main outcomes you would like to achieve from having personal training/coaching?
How long would you say it would expect to achieve that?
3 Month
6 months
1-2 years
More
Do you want to add anything else you feel would benefit my understanding of you and what you want to achieve?
Thank you for taking the time to fill this out! I'll review this and be in touch! George
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